Vacation Bible School

Children entering Kindergarten – 4th grade in Fall 2019 are welcome to join us for the mane event of the summer! This epic African adventure engages the whole herd. At Roar, kids explore God’s goodness and celebrate a ferocious faith that powers them through this wild life.

Fee: $30 per child

Registration Deadline: Saturday, August 10, 2019 – Sorry, no walk-ins will be accepted!

How many children would you like to register today?

Number of participants

Child 1

Participant’s Name

Gender

Male Female

Date of Birth

School Grade

Grade entering in September 2019

Shirt Size

Allergies (bee stings, foods, medications, etc.)

If yes, please list, including any required medications or precautions necessary for the allergy. If none, please write N/A

Is your child required to take medication or use an inhaler during camp?

If yes, please list. If none, please write N/A

Any limitations for camp activities? (i.e. physical, visual, auditory, behavioral)

If yes, please describe. If none, please write N/A

Is there any other information that is important for us to know about your child?

If none, please write N/A

Child 2

Participant’s Name

Gender

Male Female

Date of Birth

School Grade

Grade entering in September 2019

Shirt Size

Allergies (bee stings, foods, medications, etc.)

If yes, please list, including any required medications or precautions necessary for the allergy. If none, please write N/A

Is your child required to take medication or use an inhaler during camp?

If yes, please list. If none, please write N/A

Any limitations for camp activities? (i.e. physical, visual, auditory, behavioral)

If yes, please list. If none, please write N/A

Is there any other information that is important for us to know about your child?

If none, please write N/A

Child 3

Participant’s Name

Gender

Male Female

Date of Birth

School Grade

Grade entering in September 2019

Shirt Size

Allergies (bee stings, foods, medications, etc.)

If yes, please list, including any required medications or precautions necessary for the allergy. If none, please write N/A

Is your child required to take medication or use an inhaler during camp?

If yes, please list. If none, please write N/A

Any limitations for camp activities? (i.e. physical, visual, auditory, behavioral)

If yes, please list. If none, please write N/A

Is there any other information that is important for us to know about your child?

If none, please write N/A

Child 4

Participant’s Name

Gender

Male Female

Date of Birth

School Grade

Grade entering in September 2019

Shirt Size

Allergies (bee stings, foods, medications, etc.)

If yes, please list, including any required medications or precautions necessary for the allergy. If none, please write N/A

Is your child required to take medication or use an inhaler during camp?

If yes, please list. If none, please write N/A

Any limitations for camp activities? (i.e. physical, visual, auditory, behavioral)

If yes, please list. If none, please write N/A

Do you have a friend you would like to be placed with? If so, who?

If none, please write N/A

Page Break

Parent

Parent / Guardian

Are you a registered member of our Parish?

Yes No

Address

E-mail Address

Cell Phone

Emergency/Pick-up Information

Please list additional adult contacts that could be called during camp hours (9:15am-12:15pm) in the case of an emergency. If you cannot be reached, the individuals listed below are the only individuals authorized to pick up your child in addition to the Parent(s)/Guardian(s) listed. We will not release your child to anyone that is not listed without written permission.

Emergency Contact Name

Relationship

Phone

Alternate Pickup Name

Relationship

Phone

I understand that in the case of injury or illness, every effort will be made to contact me in a medical emergency. In the event I cannot be reached, I give permission to parish staff to secure all proper and necessary treatment for my child(ren). I understand that no liability is assumed by the church or the Archdiocese for claims that may arise.

I agree

Parental Consent for Medical Care: In case of an emergency, I give permission for my child to receive emergency medical treatment and, if necessary, be transported to the nearest appropriate medical facility.

I agree

I understand that photos of my child(ren) may be taken and used in Parish publications including web and print media. Children will not be identified by name.

I agree I disagree

Current Date

Total Amount

Verification