VBS Registration Form

Name of Child(Required)

Child's Gender

Type of Participation(Required)

Age of Child(Required)

Date of Birth(Required)

Last School Grade Completed(Required)

Allergies, Medical Conditions, or Special Needs?

Do you have a second child?(Required)

Yes

Name of Child(Required)

Child's Gender

Type of Participation(Required)

Age of Child(Required)

Date of Birth(Required)

Last School Grade Completed(Required)

Allergies, Medical Conditions, or Special Needs?

Do you have a third child?(Required)

Yes

Name of Child(Required)

Child's Gender

Type of Participation(Required)

Age of Child(Required)

Date of Birth(Required)

Last School Grade Completed(Required)

Allergies, Medical Conditions, or Special Needs?

Name of Parents/Guardians(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Parish of Registration(Required)

Emergency Contact Info(Required)

First Last

Phone(Required)

Relationship to Family(Required)

People Authorized to Pick-Up/Drop-Off Child 1(Required)

People Authorized to Pick-Up/Drop-Off Child 2

People Authorized to Pick-Up/Drop-Off Child 3

Celebrate Mass With Us

Celebrate Mass With Us

VBS Registration Form