Clone of VBS 2025 Registration Form

Vacation Bible School - 2026 Monday, June 22 - Friday, June 26 Registration Form

Rainforest Falls Vacation Bible School is open to all children entering Kindergarten through 5th Grade. VBS will be held from 9:00am to 12:30pm daily, followed by a family picnic on the last day. Cost for participants is $15 for one child and $30 for two or more children per family. Payments can be made to St Patrick Church by check, cash or through St. Patrick's e-giving platform. Snacks will be provided each day. VBS is open to all Portage County parishes. VBS will be held at the University Parish Newman Center located at 1424 Horning Rd, Kent, OH 44240. Please contact Jamie Schall, DRE with questions at 330-673-5849 or jschall@youngstowndiocese.org.
Student's Full Name*

First NameMiddle NameLast Name
Student's Date of Birth*

MonthDayYear
Date
MaleFemale
KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5
Immaculate Conception ParishSt Patrick ParishSt Patrick SchoolUniversity Parish Newman CenterSt John Neumann ParishSt Joseph SchoolOther
Child XS (2-4)Child SM (6-8)Child MED (10-12)Child LG (14-16)Adult SmallAdult MediumAdult Large
Mother/Guardian Name*

First NameLast NameMaiden Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Father/Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Family Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Number in Case of Emergency (Cell, Work, Etc.)
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact (In case a parent cannot be reached)

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please list the names of persons that the student is permitted to be released to in addition to parents/legal guardians:

NameRelationship to the Student
NameRelationship to the Student
I GIVE my consent for the transfer of my child to any hospital that is accessible and the administration of any treatment deemed necessary by the attending physician.This authorization does not cover major surgery unless in the medical opinion of two other licensed physicians or dentists such surgery is absolutely necessary and these opinions are obtained prior to the performance of surgeryI DO NOT GIVE my consent to emergency medical treatment. Describe desired action to be taken:
Medical or Special Concerns

Please indicate any information that would be helpful in the case of an accident or an emergency. Include any allergies, physical impairments and/or medication your child takes on a regular basis. Also use this area to give any information of which you would like your child’s instructor to be aware. Attach an extra page if necessary.
Permission For Name And/Or Image Use
I GIVE permission for my child's name or image to be included in publicity releases about parish events in the bulletin, parish website, parish Facebook page, and local or diocesan newspaper.DO NOT use my child’s name or image in public media.
I, the parent/guardian of the above named child, who is less than nineteen years of age, grant permission for my daughter/son to participate in the Vacation Bible School at University Parish Newman Center Monday, June 23, 2025 – Thursday, June 26, 2025. By allowing my child to participate in the said program, I hereby assume all risk of accident or harm arising or growing out of, directly or indirectly, any incident of any kind occurring during the course of such program to my child and do hereby release and discharge the Bishop of the Diocese of Youngstown, and parish/school/organization, and the agents, associates, and employees of the Bishop and parish/school who have organized or participated in the supervision of such program from all claims, demands, suits, causes or actions, rights, costs, expenses, and any compensations whatsoever which may occur to my family and its members during or resulting from participating in the program mentioned.*
Date*

MonthDayYear
Date
Payments can be made to St Patrick Parish via Check, Cash, or through on-line giving. To pay online go to st patrickkent.org and click on the e-giving link at the bottom of the page.
Should be Empty:

Vacation Bible School - 2026 Monday, June 22 - Friday, June 26 Registration Form

Medical or Special Concerns

Permission For Name And/Or Image Use