2024 VBS Registration 2024 VBS Participant Registration Form Name of Adult* First Last Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mobile Number*Emergency Contact Name* First Last Emergency Contact Phone*Number of Children*SelectOne (1)Two (2)Three (3)Four (4)Five (5)Six (6)Child's Name* First Last Child's Birthdate* MM slash DD slash YYYY Child's Age*Child's Grade in Fall* Child's T-shirt Size*SelectSmallMediumLargeX-LargeChild's allergies, food restrictions*Second Child's Name* First Last Second Child's Birthdate* MM slash DD slash YYYY Second Child's Age*Second Child's Grade in Fall* Second Child's T-shirt Size*SelectSmallMediumLargeX-LargeSecond Child's allergies, food restrictions*Third Child's Name* First Last Third Child's Birthdate* MM slash DD slash YYYY Third Child's Age*Third Child's Grade in Fall* Third Child's T-shirt Size*SelectSmallMediumLargeX-LargeThird Child's allergies, food restrictions*Fourth Child's Name* First Last Fourth Child's Birthdate* MM slash DD slash YYYY Fourth Child's Age*Fourth Child's Grade in Fall* Fourth Child's T-shirt Size*SelectSmallMediumLargeX-LargeFourth Child's allergies, food restrictions*Fifth Child's Name* First Last Fifth Child's Birthdate* MM slash DD slash YYYY Fifth Child's Age*Fifth Child's Grade in Fall* Fifth Child's T-shirt Size*SelectSmallMediumLargeX-LargeFifth Child's allergies, food restrictions*Sixth Child's Name* First Last Sixth Child's Birthdate* MM slash DD slash YYYY Sixth Child's Age*Sixth Child's Grade in Fall* Sixth Child's T-shirt Size*SelectSmallMediumLargeX-LargeSixth Child's allergies, food restrictions*Anything specific that we should know about your child(ren)? Any specific friends that you would like your child(ren) to be with in a group? NOTE: We may not be able to accommodate all requests but we will do our best! Who has permission to pick-up your child(ren)?* Publication Permission Form for Photographing, Printing, and Publishing: I agree to the publication permission policy and indicate my consent by my electronic signature below.I, the undersigned, give permission to the director of VBS and/or the youth minister of St. James Church to take and publish photographs of my child for use/publication in parish bulletins, parish bulletin boards, parish/diocesan newsletters, parish/diocesan internet websites, and the diocesan newspaper.SignatureDate MM slash DD slash YYYY 5th and 6th grade permission form (ONLY 5th and 6th) I agree to the permission form and indicate my consent by my electronic signature below.I (We), parent(s)/guardian(s) request that my child be allowed to participate in the activities and events scheduled for the VBS 5th and 6th grade group. I (WE) further give my (our) permission for our child to ride in any vehicle designated by the adult in whose care my (our) child has been entrusted while participating in the above activities. In consideration of permitting my (our) child to attend and/or participate, I (we) do hereby, for myself (ourselves) and my (our) child (children) waive and release any and all claims that I might have against Olivia Dvorjak, Saint James Church and any designated driver of a van, bus, car or vehicle, for any and all injuries or losses suffered by said child (children) while engaged in the above activities. In case of any medical emergency, I understand that every effort will be made to contact the parents or guardians of the child participating in Vacation Bible School. In the event that I cannot be reached, I hereby give permission to the physician selected by Olivia Dvorjak to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child, as named herein.SignatureDate MM slash DD slash YYYY Total $0.00 Method of Payment* Credit Card Check (Please drop off at school or parish office– made payable to Saint James Church) Other Credit CardCard Details Cardholder Name Δ Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Pinterest (Opens in new window)Click to print (Opens in new window)MoreClick to share on Tumblr (Opens in new window)Click to share on Pocket (Opens in new window)Click to share on Reddit (Opens in new window)