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Life is Wild, God is Good

Vacation Bible School at St. Ben's
JULY 22-26, 2019

Kindergarten - 5th Grade

Monday - Friday 9 a.m. to 2:30 p.m.

Questions? Contact Nancy at nuczen@stbenedict.com

or (773) 588-6484 ext. 1272

Registration fee: $60/child

(T-shirt included in registration fee. Choose t-shirt size below)

Child/Children Information

Child"s Name*

Grade Level in September 2019*

Child"s Name

Grade Level in September 2019

Child"s Name

Grade Level in September 2019

Child"s Name

Grade Level in September 2019

Address*

City*

State*

ZIP*

Parent Information

Parent/Guardian Name*

Preferred Phone Number*

Preferred Email Address*

Parent/Guardian Name

Preferred Phone Number

Preferred Email Address

In Case of Emergency

Name*

Relationship*

Preferred Phone Number*

Please list any medical information which may be helpful (allergies, diabetes, asthma, etc.). Make sure to include name of child:

Electronic signature - consent for child(ren) to participate in the VBS program:*

Date*

Date

T-shirts are included in the $60 registration fee. Your t-shirt will be ready the first day of Shipwrecked. Please indicate your t-shirt size below.

Youth Shirt Size:

YXS (6-8)YS (8-10)YM (10-12)YL (12-14)

Youth Shirt Size:

YXS (6-8)YS (8-10)YM (10-12)YL (12-14)

Adult Shirt Size:

SMLXL

Adult Shirt Size:

SMLXL

Quantity:

12

Quantity:

12

Quantity:

12

Quantity:

12

Payment Information

Contact me! I would like to volunteer!

YesNo

All payments are due no later than Monday, July 1, 2019.

CLICK HERE TO PAY ONLINE

If you are paying by check, please make checks payable to St. Benedict Parish and mail to: St. Benedict Parish, 2215 W. Irving Park Road, Chicago, IL 60618 Attn: VBS Nancy Uczen

PLEASE BE SURE TO HIT THE SUBMIT BUTTON AT THE BOTTOM OF THIS FORM ONCE YOU HAVE FINISHED MAKING YOUR ONLINE PAYMENT! THANK YOU!