St. Catherine of Siena Catholic Church Children's Vacation Bible School Registration Form

St. Catherine of Siena Catholic Church Children's Vacation Bible School Registration Form
Institution Name
Child/Children INFORMATION
Name*

First NameLast Name
Birth Date *

MonthDayYear
Date
Gender*
Grade completed*
Child's T-Shirt Size*

Child's SmallChild's MediumChild's LargeChild's X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Gender
Grade completed *
Child's T-Shirt Size

Child's SmallChild's MediumChild's LargeChild's X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Gender
Grade completed by
Child's T-Shirt Size

Child's SmallChild's MediumChild's LargeChild's X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Gender
Grade completed by
Child's T-Shirt Size

Child's SmallChild's MediumChild's LargeChild's X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Home Church (If not St. Catherines)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian*

First NameLast Name
Relationship to child*
Phone Number*
Alternate Guardian #1

First NameLast Name
Relationship to child
Phone Number*
Medical Information
Please list all allergies -- or type "none" if there are none*
Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)*

YesNo
Please list all medical concerns -- or type "none" if there are none*
Additional Information
Please list the names of any other children (friends or family) that you would like placed in the same class as this child
VBS photos/videos are taken for promotional purposes related to St. Catherine's Catholic Church and Vacation Bible School. These pictures appear in various media outlets such as our facebook page and webpage. Do you allow your child to be included in these photos/videos?*

YesNo
How will you pay for the T-Shirt?*

Cash - Please bring your payment to the office.Check - Please write VBS in the memo and bring your payment to the office or mail it to 1649 Kingsley Ave., Orange Park, FL 32073Credit - Please pay using the form below

Vacation Bible School T-Shirts

VBS T-ShirtThe VBS t-shirt is $15.00 per child. Please enter how many shirts you would like to purchase

$15.00 Quantity

Total

$0.00

Credit Card

By submitting this form, I ackowledge I have read and understand the above information.
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St. Catherine of Siena Catholic Church Children's Vacation Bible School Registration Form

Medical Information

Additional Information

Credit Card