Vacation Bible School

Registration

Child’s Information

Name *

Age *

Birthdate *

Medical Information *

Child’s T-Shirt Size

What grade is your child registered in for 2023-24 school year? *

Guardian Information

Mother’s Name *

Mother’s Cell Phone *

Mother’s Email *

Mother’s Address *

Is the mother a custodial parent? *

Yes

Father’s Name *

Father’s Cell Phone *

Father’s Email *

Father’s Address *

Is the father a custodial parent? *

Yes

Emergency Contact Person

Emergency Contact’s Name *

Emergency Contact Phone *

Names of People Authorized for Pickup *

Release: To the fullest extent permitted by law, I release Immaculate Heart of Mary Parish, its trustees, officers, directors, employees, agents and representatives from any illness, injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless Immaculate Heart of Mary Parish, its employees, volunteers and representatives from any claims arising out of my minor child’s participation in the activity.

General: I give my consent for my child(ren) to attend meetings, activities and events, both on site and off site. I will be provided specific event information in advance of any off-site activity.

Medical: In the event of a medical emergency and when a contact cannot be made to me and/or the emergency contact listed, I give my permission for my child(ren) to receive appropriate medical attention. In the event of an emergency or accident, I release Immaculate Heart of Mary Parish, its employees and volunteers, and all those related to it, from any liability. I have provided emergency contacts and am assured that I will be contacted as soon as possible in the event of an emergency.

Transportation: Should transportation be needed, I agree to allow my child(ren) to ride with church staff or volunteers. Appropriate safety standards will be maintained and children will always be provided seatbelts. If no such permission is granted, I agree to transport my child(ren) to and from any offsite event. I understand that it is my child(ren)’s responsibility to wear his/her seatbelt.

Photograph release: Photos may be taken during VBS, Sunday school, worship, youth group events, or other church activities. I grant permission for Immaculate Heart of Mary Parish to post photos including my child(ren) on its website, social media or in other church publications.

By typing your fill name in this field, you are agreeing to and signing this registration form: *

Today’s Date *

Please input the email address a copy of your registration form can be sent to *