Vacation Bible School

IT’S COMING…IT’S COMING…VBS IS COMING! REGISTER NOW!

Parachute with the Angels and St. Catherine Laboure

June 17 – 21 9:00AM – 12:00PM

Ages: 4 Yr. Olds to Rising 5th Graders

(Nursery care available for volunteers)

For more information contact Kelly Rush

kelly4VT@gmail.com

VBS Registration Form 2019

Cost
How many children are you enrolling?*
Cost is $50 for the 1st child, and $25 for each additional child.
I would also like to purchase...
- Nothing, thank you, just the registration.
- Angel of God Music CD
- Saint Catherine Laboure Storybook
- Both the CD and Storybook
Total
$0.00
Student Information
Child's Full Name*
Child's Grade Level as of Fall 2019*
Child's T-Shirt Size*
Gender*
2nd Child
2nd Child's Full Name*
2nd Child's Grade Level as of Fall 2019*
2nd Child's T-Shirt Size*
Gender*
3rd Child
3rd Child's Full Name*
3rd Child's Grade Level as of Fall 2019*
3rd Child's T-Shirt Size*
Gender*
4th Child
4th Child's Full Name*
4th Child's Grade Level as of Fall 2019*
4th Child's T-Shirt Size*
Gender*
Additional Information
Name(s) of Parent(s) or Guardian(s)*
Parent Email*
Address of Parent(s) or Guardian(s)*
Street Address City State ZIP Code
Parent Home/Cell Phone
Parent Work Phone
Name of Home Church*
Emergency Contact 1 Name*
Please name two other people other than parents to be notified in an emergency.
Emergency Contact 1 Phone*
Emergency Contact 2 Name*
Emergency Contact 2 Phone*
Who may pick up your children from VBS?*
Please name the pick-up people.
Special Requests
If you would like your child to be placed in the same class as another child, please explain in the text area below. PLEASE NOTE: NO CHANGES WILL BE MADE AFTER MAY 15th. If you would like to make a request, please do this now and explain in detail. No more than one "friend-request" will be allowed. Thank you for your understanding. Please note that requests are not guaranteed.
Allergy Information

Allergies: Please explain pertinent allergy information in the box below.
Would you like to volunteer? (registration discount given for adult volunteer)*
Medical Release
Medical Release*
Please indicate your agreement with the following medical release:
In the event of an emergency or non-emergency situation in which medical treatment is required for my child as a result of participation with the 2019 Vacation Bible School program held at St. Theresa, Ashburn, VA, I authorize the on-site adult leaders, volunteers, and staff members to act as my agents and thereby consent to emergency medical treatment. I understand that every reasonable attempt will be made to contact me in the event of an emergency.
- I agree with the above medical release.
Name of parent digitally signing medical release*
Please type your name.
Photography Release
Photography Release*
During VBS, photographs may be taken by St. Theresa Church for use in the closing ceremony at the end of the week. Any photographs used will NOT include the names of children. Please choose one option.
- I give permission for photographs of my sons/daughters to be used.
- I do not give permission for photographs of my sons/daughters to be used.
Student Drop Off/Pick Up Information*
Students cannot be dropped off prior to 8:50AM. Students must be picked up promptly at 12:00PM. PLEASE NOTE: **Only drop off exception is the first day of VBS. Drop off will be at 8:40AM**.
- I have read and understand the above drop off/pick up procedures.
Name of parent digitally signing permission to photograph*
Please type your name.
Other information or comments
Comments
This field is for validation purposes and should be left unchanged.

Vacation Bible School

IT’S COMING…IT’S COMING…VBS IS COMING! REGISTER NOW!

Parachute with the Angels and St. Catherine Laboure

June 17 – 21 9:00AM – 12:00PM

Ages: 4 Yr. Olds to Rising 5th Graders

(Nursery care available for volunteers)

For more information contact Kelly Rush

kelly4VT@gmail.com

VBS Registration Form 2019

Cost

Student Information

2nd Child

3rd Child

4th Child

Additional Information

Medical Release

Photography Release