Vacation Bible School Registration

Child's name

First NameLast Name

In the Fall of 2026, what grade will your child be entering into?

Please list any allergies your child has:

What church does your child attend?

Is your child Catholic?

Has your child received First Communion?

Parent(s) Names

Parent Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent Email

example@example.com

Anything else parish staff and volunteers should know about your child?

Please list the name and phone number of an additional emergency contact:

Photo/Video Permission: Does the Diocese of Springfield-Cape Girardeau have permission to use photographs/videos of your child for diocesan/parish/school materials and campaigns, as well as other media initiatives; i.e. newsletters, websites, fund development efforts, newspapers, and television? Holy Trinity may post pictures of VBS on our Facebook page.

Other

Emergency Medical Treatment Permission
In the event of an emergency, I/we hereby give permission to transport my/our child to a hospital for treatment by the hospital or doctor. I wish to be advised prior to any further treatment by the hospital or doctor. I/we further give my/our permission for health officials to release medical information on my/our child to the diocesan group leader, if applicable.

Liability Waiver
I/we agree, on behalf of myself/ourselves, my/our child named herein, my/our and my/our child’s heirs, successors and assigns, to hold harmless and defend the parish and the Diocese of Springfield-Cape Girardeau, their officers, directors, employees, volunteers, agents, chaperones, and representatives associated with the event, from any claim arising from or in connection with my/our child attending the event, from any claim arising from or in connection with any illness or injury (including death) or in connection with the cost of medical treatment as a result of an illness or injury, even if the cause of damages or injury is alleged to be the fault of or caused by the negligence of the parish or the Diocese. I/we agree to compensate the parish or Diocese, their officers, directors, employees, agents and chaperones or representatives associated with the event for reasonable attorney’s fees and expenses which they may incur in any action brought against them as a result of such injury or damage, unless such a claim arises from the negligence of the parish or Diocese.

I/we warrant that the information herein is correct to the best of my/our knowledge.

I/we fully understand and sign this Parental/Guardian Consent Form and Liability Waiver knowingly, freely and willingly.

Signature