VBS Family Registration Form

Family Last Name(Required)

Are you members of St. Sebastian Church?(Required)

Yes

No, but would like information on joining

Child Registration

Please fill out below for each child you are registering. We will be grouping children more by age this year. So we will not be taking requests to be with certain friends.

Child 1 Name(Required)

First Last

Child 1 Grade Entering in the Fall(Required)

Child 2 Name

First Last

Child 2 Grade Entering in the Fall

Child 3 Name

First Last

Child 3 Grade Entering in the Fall

Child 4 Name

First Last

Child 4 Grade Entering in the Fall

Child 5 Name

First Last

Child 5 Grade Entering in the Fall

Parent/Guardian Information

Parent/Guardian 1 Name(Required)

First Last

Parent/Guardian 2 Name

First Last

Email(Required)

Please provide an email address to receive correspondence regarding VBS.

Primary Phone(Required)

Please provide a phone number you will have with you during VBS times in case we need to reach you for any reason.

Secondary Phone(Required)

Please provide an alternative phone number in case we are unable to reach you at the primary phone number.

Address(Required)

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

Please list any food allergies, medical needs and/or any other information we need to know about your child(ren).

Media Release(Required)

As legal guardian, I understand that photos and videos of participants may be taken during this time. I am the parent/guardian of those listed on this sheet, and I hereby approve and consent to the use of his/her photo or video image and name to be used for promotional purposes (bulletin, church website, newspaper, etc.).

Family Physician Name (only used in case of emergency)(Required)

Family Physician Phone Number(Required)

Health Insurance Name (only used if there is an emergency)(Required)

Health Insurance Group/Contact/Policy Number(Required)

Medical Treatment Release(Required)

As a parent/legal guardian, I do hereby authorize the treatment for the children listed on this form in the event of an emergency which may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me at the telephone numbers listed on this form. I agree to be responsible for all costs and expenses incurred in connection with said medical services. This is intended for the period of July 16-20 during St. Sebastian Parish Vacation Bible School. I understand that all reasonable safety precautions will be taken at all times by the parish and its agents during VBS. I agree not to hold St. Sebastian Parish, its leaders, employees, volunteers, or the Roman Catholic Diocese of Grand Rapids liable for damages, losses, diseases, or injuries incurred by the aforementioned.

Emergency Contact Information (other than parent)(Required)

Please provide the name, relationship to, and phone number for emergency contact person.

Emergency Contact Phone Number

Emergency Contact Relationship to Child(Required)

Other

If there are any positions still open, I would interested in helping- please contact me.

Contact me for any donations needed

I can assist with preparing items at home

I can help with set (date TBD)

I can assist with clean up immediately following the event on Thursday, July 20

I would like to lead one of the craft, games, faith, or snack stations

I could assist wherever it is needed

2023 STELLAR VBS Family Registration Form (one per family)

Child Registration

Parent/Guardian Information