Clone of VBS 2025

St. Patrick Parish VBS 2026
How many children are you registering? ¿Cuantos niños va a inscribir a la Escuela Bíblica de Verano (VBS por sus siglas en inglés)?*
Child Information / Información del niño/a
First Child / Niño 1
Child's Name / Nombre del Niño/a*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).*
In case of medical emergency, I understand that every effort will be made to communicate with the aforementioned emergency contact person. In the event that this person cannot be contacted, by signing or electronically submitting this form I give permission for the above mentioned child to be evaluated, diagnosed, treated and/or medicated by licensed medical personal.
Second Child / Niño 2
Child's Name / Nombre del Niño/a*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).*
In case of medical emergency, I understand that every effort will be made to communicate with the aforementioned emergency contact person. In the event that this person cannot be contacted, by signing or electronically submitting this form I give permission for the above mentioned child to be evaluated, diagnosed, treated and/or medicated by licensed medical personal.
Third Child / Niño 3
Child's Name / Nombre del Niño/a*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).*
In case of medical emergency, I understand that every effort will be made to communicate with the aforementioned emergency contact person. In the event that this person cannot be contacted, by signing or electronically submitting this form I give permission for the above mentioned child to be evaluated, diagnosed, treated and/or medicated by licensed medical personal.
Fourth Child / Niño 4
Child's Name / Nombre del Niño/a*

First NameLast Name
Child's Birth Date / Fecha de nacimiento del niño/a*

MonthDayYear
Last Grade Completed / Grado escolar*
Medical or other information we may need to know about the child (including food allergies).*
In case of medical emergency, I understand that every effort will be made to communicate with the aforementioned emergency contact person. In the event that this person cannot be contacted, by signing or electronically submitting this form I give permission for the above mentioned child to be evaluated, diagnosed, treated and/or medicated by licensed medical personal.
Child Release Information
Parent/Legal Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Text Msg. Number

Area CodePhone Number
E-mail
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names of Persons to which the child (children) may be released to after VBS *

First NameLast Name
Full Name*

First NameLast Name
Full Name

First NameLast Name
Full Name

First NameLast Name
Are there any persons to which the child (children) may NOT be released to?*

YesNo
Who may your child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)

First NameLast Name
Emergency Contact 2 Phone Number

Area CodePhone Number
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website. Names will not be published.

I AgreeI do not Agree
Should be Empty:

St. Patrick Parish VBS 2026

Child Information / Información del niño/a

First Child / Niño 1

Second Child / Niño 2

Third Child / Niño 3

Fourth Child / Niño 4

Child Release Information

Media Release