Vacation bible registration form 2023

Vacation Bible Registration Form 2023

Family Name*
How many children in grades k-6 are you enrolling?*
How many junior counselors grade 7 & up are joining?*
Child 1 First Name*
Child 1 Last Name*
Child 1 D.O.B*
MM slash DD slash YYYY
Child 1 M/F*
Child 1 grade in September*
T-shirt Size*
Child 2 First Name*
Child 2 Last Name*
Child 2 D.O.B*
MM slash DD slash YYYY
Child 2 M/F*
Child 2 grade in September*
T-shirt Size*
Child 3 First Name*
Child 3 Last Name*
Child 3 D.O.B*
MM slash DD slash YYYY
Child 3 M/F*
Child 3 grade in September*
T-shirt Size*
Child 4 First Name*
Child 4 Last Name*
Child 4 D.O.B*
MM slash DD slash YYYY
Child 4 M/F*
Child 4 grade in September*
T-shirt Size*
Child 5 First Name*
Child 5 Last Name*
Child 5 D.O.B*
MM slash DD slash YYYY
Child 5 M/F*
Child 5 grade in September*
T-shirt Size*
Child 6 First Name*
Child 6 Last Name*
Child 6 D.O.B*
MM slash DD slash YYYY
Child 6 M/F*
Child 6 grade in September*
T-shirt Size*
1st Junior counselor First Name*
1st Junior counselor D.O.B*
MM slash DD slash YYYY
1st Junior counselor M/F*
1st Junior counselor grade in september*
1st T-shirt Size*
2nd Junior counselor First Name*
2nd Junior counselor D.O.B*
MM slash DD slash YYYY
2nd Junior counselor M/F*
2nd Junior counselor grade in september*
2nd T-shirt Size*
3rd Junior counselor First Name*
3rd Junior counselor D.O.B*
MM slash DD slash YYYY
3rd Junior counselor M/F*
3rd Junior counselor grade in september*
3rd T-shirt Size*
4th Junior counselor First Name*
4th Junior counselor D.O.B*
MM slash DD slash YYYY
4th Junior counselor M/F*
4th Junior counselor grade in september*
4th T-shirt Size*
5th Junior counselor First Name*
5th Junior counselor D.O.B*
MM slash DD slash YYYY
5th Junior counselor M/F*
5th Junior counselor grade in september*
5th T-shirt Size*
Parent(s)/Guardian Information
Parent/Guardian Name*
Address*
Phone:(H)*
(C)*
Email*
Phone to be contacted during VBS:*
Emergency Contact other than Parent/Guardian(listed above):*
Person who will pickup child (will need ID)
Name*
Phone*
Name
Phone
Additional Information (Please indicate child’s name next to Special Consideration and Allergies)
Special Considerations:
Allergies:*
Faith Formation takes photographs of children during the week to be used in slide show and/or parish website.*

I DO give permission for my child’s likeness/name to be included.

I DO NOT give permission for my child’s likeness/name to be included.
Signature of Parent/Guardian*
Date:*
MM slash DD slash YYYY
1 Student Fee
Price:
2 or 2+ children Fee
Price:
1 Junior counselor Fee
Price:
2 Junior counselor Fee
Price:
3 Junior counselor Fee
Price:
4 or 4+ Junior counselor Fee
Price:
Total
$0.00
* Full payment of fee is required when you submit this Registration Form. Please proceed to the next page for payment information and complete the registration. If you are unable to pay now, please contact the Faith Formation Office.

20 Chestnut Street, Centereach, NY 11720

631-585-8760 GIVE

Vacation Bible Registration Form 2023

Parent(s)/Guardian Information

OUR PARISH

SACRAMENTS

PEER MINISTRIES

FAITH FORMATION

LITURGY

MINISTRIES

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