VBS 2026 Registration Form

VBS 2026 Registration Form

June 22nd to June 26th from 9am to 12pm daily
Parent 1 Name*

First NameLast Name
Parent 1 Email Address*
example@example.com
Parent 1 Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent 2 Name*

First NameLast Name
Parent 2 Email Address*
example@example.com
Parent 2 Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
YesNoNo, but would like information.No, registered somewhere else.
Student 1 Name*

First NameLast Name
Student 1 Date of Birth*

MonthDayYear
Date
Student 1 Grade Level*
Student 1 Allergies*
If none, please write N/A.
Student 1 Shirt Size*
Student 2 Name

First NameLast Name
Student 2 Date of Birth

MonthDayYear
Date
Student 2 Grade Level
Student 2 allergies
If none, please write N/A.
Student 2 Shirt Size
Student 3 Name

First NameLast Name
Student 3 Date of Birth

MonthDayYear
Date
Student 3 Grade Level
Student 3 Allergies
If none, please write N/A.
Student 3 Shirt Size
We respectfully invite you to share any information that would assist us in caring for and ministering to your child(ren) this week. This may include relevant physical or mental health conditions, learning needs or behavioral considerations. Please be assured that all information will be treated with the utmost confidentiality and used solely to support your child(ren)'s well being in a safe, respectful and Christ-centered environment. If you are registering multiple children please be clear as to who this applies to.
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Please list any other additional adults who may pick your child up and their contact number*
If none, please list N/A
Medical Release
I have fully answered this Medical Release Form to the best of my knowledge. I also understand that in the event medical intervention is necessary, every attempt will be made to contact immediately the persons listed on this form. If I cannot be reached in an emergency during Religious Education, I give my permission to the physician selected by the activity leader to hospitalize in order to secure medical treatment and/or an injection, anesthesia, or surgery for my child(ren) as deemed necessary. I have read and fully understand the requirements outlined by St. Joseph the Worker Catholic Church. By signing this form, I accept the requirements stated in this Medical Release Form.
Preferred Hospital & Primary Physician*
Insurance Carrier*
Policy/ID Number*
Name of Policy Holder*
Media Release
I give permission for St. Joseph the Worker Catholic Church to include photos and videos of my child(ren) from church events in St. Joseph the Worker Catholic Church publications including media presentations, brochures, bulletin boards, our website and bulletin.I DO NOT give permission for St. Joseph the Worker Catholic Church to include photos and videos of my child(ren) from church events in St. Joseph the Worker Catholic Church publications including media presentations, brochures, bulletin boards, our website and bulletin.
Signature*

Powered by Jotform SignClear
Should be Empty:

VBS 2026 Registration Form

Medical Release

Media Release