Vacation Bible School 2022

Vacation Bible School 2022

Registration Form
Family Name *
Parent(s) Name(s) *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Email *
example@example.com
Home Phone: *
Please enter a valid phone number.
Cell/Work Phone *
Please enter a valid phone number.
If there is a person/other that the parent that will be picking up child/children-please enter their full name.
Please check all dates that this person will be picking up.

Sun. 7/17/2022 Monday 7/18/2022 Tuesday 7/19/2022 Wednesday 7/20/2022 Thursday 7/21/2022 Friday 7/22/2022
Phone Number of person picking up if other than parent
Please enter a valid phone number.
In Case of Emergency- please contact (other than a parent) *
Relationship of Emergency Contact Person *
Home Phone of Emergency Contact Person *
Please enter a valid phone number.
Cell Phone of Emergency Contact Person *
Please enter a valid phone number.
Child 1 - Name *
Date of Birth *

Month Day Year
Date
Grade in the Fall of '22
Health issues/needs/medications:
Child 2 - Name
Date of Birth

Month Day Year
Date
Grade in the Fall of '22
Health issues/needs/medications:
Child 3 - Name
Date of Birth

Month Day Year
Date
Grade in the Fall of '22
Health issues/needs/medications:
Child 4 - Name
Date of Birth

Month Day Year
Date
Grade in the Fall of '22
Health issues/needs/medications:
All medications except inhalers must be turned into volunteers to be kept in a secure location. Please notigy the parish coordinator (Savannah Price) about any serious conditions that require close supervision. youthminister@newmanniu.org

Thank you
I hereby give permission for my child/children to participate in Vacation Bible School at Christ the Teacher Center Catholic Church in Dekalb, IL , July 18th-22nd. I hereby release and indemnify the Diocese of Rockford and its Bishop, Christ the Teacher Catholic church, the staff and volunteers from all claims for personal injuries or property damage that my child/children may suffer while participating in this program.
Signature

Clear
I would be able to bring Kool-aid/lemonade mix
I would e able to bring a snack (veggies, cheese & cracker, cookies, fruit)
Cost -

Grades 1-6 $25 per child

Grades 7-8 $10 per child

Maximum $50 per family

T-shirts will be available during the week of VBS. They will be $10 a piece. If you would like to preorder a shirt, Please complete form below for sizes.

Please include the t-shirt cost with the cost of the cost of the camp when preordering. Preorderfor t-shirt must be submitted by July 3rd.

Youth T- Shirt Sizes

	Youth X-Small	Youth Small	Youth Medium	Youth X-Large
Child 1
Child 2
Child 3
Child 4
Adult Volunteer

Adult T- Shirt Sizes

	Adult Small	Adult Medium	Adult Large	Adult X-Large	Adult 1	Adult 2	Adult 3	Adult 4
Child 1
Child 2
Child 3
Child 4
Adult Volunteer

I hereby give permission for any photgraphs which include my child/children to be used in various parish communications and diocesan newspaper.
Signature

Clear
Today's Date

Month Day Year
Date
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