SCUBA Vacation Bible School (VBS) 2024- Registration and Emergency Release Form
Sacred Heart Catholic Church · 655 C AVENUE · CORONADO, CA · 92118
VBS- Participants (Kinder-6th Grade)
Dates: June 24th-28th, 2024 Time: 9:30-12:30 pm Location: Sacred Heart Parish Cost: $100
VBS- Junior Leader (entering 7-8th Grade)
Leader Orientation: Tuesday June 18th 6:30 pm Dates: June 24th-28th, 2024 Time: 9:00-12:45 pm Location: Sacred Heart Parish Cost: $75
VBS- Teen Captain (entering 9th-12th Grade)
Leader Orientation: Tuesday June 18th 6:30 pm Dates: June 24th-28th, 2024 Time: 9:00-12:45 pm Location: Sacred Heart Parish Cost: No cost
Parent or Guardian Information
Is your family Registered Sacred Heart Parishioners?
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Please Select
Yes
No
I'm not sure
Parent/Guardian #1 Name
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First Name
Last Name
Parent/Guardian #1 Email
*
example@example.com
Parent/Guardian #1 Phone Number
*
Please enter a valid phone number.
Parent/Guardian #2 Name
First Name
Last Name
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Information (Non-Parent)
Name
*
First Name
Last Name
Relationship to Child/Children
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Phone Number
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Please enter a valid phone number.
Child Information
Submit for VBS Participants, JR. Leader and High School Leaders
Child #1
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First Name
Last Name
T- Shirt Size
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Please Select
Youth XS
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Date of Birth
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-
Month
-
Day
Year
Date
Fall 2024 Grade
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Please Select
N/A
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Gender
*
Please Select
Male
Female
N/A
Is there anything we need to be aware of (family needs, allergies, medical condition, learning disabilities, etc.)?
Child #2
First Name
Last Name
T- Shirt Size
Please Select
Youth XSmall
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Date of Birth
-
Month
-
Day
Year
Date
Fall 2024 Grade
*
Please Select
N/A
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Gender
*
Please Select
Male
Female
N/A
Is there anything we need to be aware of (family needs, allergies, medical condition, learning disabilities, etc.)?
Child #3
First Name
Last Name
T- Shirt Size
Please Select
Youth XS
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Date of Birth
-
Month
-
Day
Year
Date
Fall 2024 Grade
*
Please Select
N/A
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Gender
*
Please Select
Male
Female
N/A
Is there anything we need to be aware of (family needs, allergies, medical condition, learning disabilities, etc.)?
Release Form Information
This Emergency Card (EC) will be accessible by the adult in charge during all on-site events, local Coronado activities involving walking and/or biking, and it will be referred to if other Medical Information is not provided. Additionally, this EC covers the anticipated events below—new or changed events require a separate form.
I, the parent/guardian remain legally responsible for any personal actions taken by my child (student(s) named above). I agree on behalf of myself, my child’s other parent if known or living, our heirs, successors, and assignees, to hold harmless and defend Sacred Heart Coronado, the Diocese of San Diego; its officers, directors, agents, volunteers, chaperones, and representatives associated with the event with respect to any and all actions, claims or demands that may be made or brought against the parish, the Diocese of San Diego; its officers, directors, agents, volunteers, chaperones, and representatives associated with the event, arising from or in connection with my child attending this event or in connection with any illness, injury or cost of medical treatment in connection therewith. I agree to compensate the parish/school, its officers, directors and agents, and the Diocese of San Diego, its employees and agents and chaperones, or representative associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the parish/school or the Diocese of San Diego.
CELL PHONE / ELECTRONIC DEVICES POLICY
To ensure a Safe (learning) Environment I understand students are encouraged NOT to bring electronic devices to VBS. If the student should bring these devices to VBS we assume NO responsibility for loss or damage of any such items. No electronic listening or recording device may be used by students during VBS hours without the leaders permission. Children may not photograph or record peers or school events without permission.
Initial if you understand the above statement
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MEDICAL TREATMENT CONSENT
In the event of an emergency and neither parent or guardian can be reached, I give my permission to the Director of Religious Education to authorize medical treatment for my child. I understand that I will be financially responsible for any medical treatment that may be necessary for the welfare of my child.
Please choose option:
*
Please Select
Yes, I herby give my consent
No, I don't give my consent
PHOTO RELEASE CONSENT
I hereby give my consent for Sacred Heart Catholic Church to use my child’s photograph and likeness to be used for any publications, including its website, Facebook, and parish bulletin. I release them from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below.
Please choose option:
*
Please Select
Yes, I herby give my consent
No, I don't give my consent
Please sign below to confirm you have read ALL the above Consent and Release Statements.
Please use the mouse holding on to the left clicker or sign with your finger on a hand held device.
Signature
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Contact
Katherine Soper- Coordinator of Religious Education and Youth cre@sacredheartcor.org (619) 435-3167 ext. 316
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Teen Leaders
If you have a Teen High School Leader please have them complete this form to complete their registration. https://forms.gle/LVP2PcMyP4Nmu5ck9
Payment
I understand that my child's registration isn't complete until payment is received by Sacred Heart Parish. You may pay by cash (no refundable) or check to Sacred Heart. VBS Participants Kinder-6th ($100) JR. Leader ($75) High School Leader (no cost)
Initial if you understand the above statement
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