Form

Ss Cyril & Methodius 2018 VBS Registration

June 25 - June 29 (10 AM - 1 PM)
9 AM Holy Mass will be celebrated daily. VBS, however, does not officially start until 10 AM.
Parent/Guardian #1

First Name Last Name
Contact Phone Number

- Area Code Phone Number
E-mail
Parent/Guardian #2

First Name Last Name
Contact Phone Number

- Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Health Insurance
Subscriber's name
Health Insurance

Provider ID Number
Emergency Contact Phone

- Area Code Phone Number
Alternate Pick-Up's Name

First Name Last Name
Alternate Pick-up's Phone

- Area Code Phone Number
Relationship to Child
I understand that reaspnable precautions will be taken to safeguard the health and wellbeing of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and coonsent the VBS team, or other associated member of the VBS program, to obtain medical care from a licensed physician, hospital, or medical clinic for my child in the event that myself or other legal guardian cannot be reached. I hereby do release and forever discharge the Diocese and Parish from all manners of actions and/or claims which I or my child named above shall or may have for any reason, arising during my child's attendance of the VBS program.
Signature

Clear
Photo Release I consent to allow my child's image to be recorded, either by photography or video, and used during VBS week or for future advertisement of Parish VBS programs and in a scrapbook of the VBS week. Any other use will require further consent.
Signature

Clear
Early registration ends June 1, 2018.

Your registration in not valid until payment has been received.

Cash or Checks to be dropped off in the front office or mailed to:

Ss Cyril & Methodius Church VBS

41233 Ryan Road Sterling Heights, MI 48314

C/O Lisa Yarbrough

1st student: $30 ($40 after June 1)

Each additional Student: $20 ($30 after June 1)

Volunteers: Please see Lisa Yarbrough
We are not a nut-free facility.

*Please let us know under special needs/allergies if you will be providing your child's snack.

IF YOUR CHILD HAS AN EPI-PEN, A PARENT MUST BE ON-SITE AT ALL TIMES
Name #1

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) Daycare (available only for volunteers)
Birth Date

Month Day Year
Catechism Grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #2

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #3

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #4

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #5

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #6

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #7

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #8

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #9

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #10

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
Name #11

First Name Last Name
Gender

Male Female
Choose one

Participant(grade K-7) Volunteer (grade 8 -adult) daycare (only if volunteering)
Birth Date

Month Day Year
Catechism grade in fall 2018
Special Needs/Allergies
T-shirt size

Child Small Child Medium Child Large Adult Small Adult Medium Adult Large Adult X Large
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Ss Cyril & Methodius 2018 VBS Registration