Clone of Course Registration Form

Christmas retreat

December 28 - 30 (2:30 PM - 7:30 PM)
Parish of Belonging
To what parish the family and child belongs to?
Name of Parish; Address; Denomination
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Father's Name

First NameLast Name
Father Mobile Number
Format: (000) 000-0000.
Father email address
example@example.com
Mother's Name

First NameLast Name
Mother Mobile Number
Format: (000) 000-0000.
Mother email address 2
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Did the student receive the Sacraments of Initiation?

Baptism & Confirmation Name

BAPTISMAL NAME (Patron Saint)CONFIRMATION NAME (Patron Saint)
Name & Location of the other Church
Fill, only if NOT Baptized, Confirmed or received first communion at St. Anthony Maronite - Cincinnati.
Denomination:
Please define Other Religious affiliation:
Special attention

Other
Please define Medical alert
Please define Learning skills
Please define Allergies:
T-Shirt size
Notes, questions or comments
Registration Fee: $25

(Includes snacks & lunch) -Paid in person at Church-
EMERGENCY CONTACT: First Name* Last Name*
Area Code* Phone Number* Relationship to child*
SIGNATURE: I grant permission for my child to attend St. Anthony of Padua Maronite Church - Cincinnati, Vacation Bible School from June 15 - 19, 2026 (VBS). I am aware that in the event of an emergency, I will be contacted and expected to be available. If I am unavailable, my emergency contact person (stated above) will be available. Overall, I am placing the well-being of my child in the care of the St. Anthony VBS staff while he/she is attending the weeklong program. I trust the judgment of the staff when it comes to the health and safety of my child and will not hold The Eparchy of Our Lady of Lebanon, St. Anthony of Padua Maronite Catholic Church - Cincinnati, VBS and its constituents liable.

I the parent / legal guardian of this child have filled this form.
Should be Empty:

Christmas retreat