Child Registration Form

Email REQUIRED Please fill out this field. Please enter an email address.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Home Address REQUIRED Please fill out this field. Please enter valid data.

Mother's Name REQUIRED Please fill out this field. Please enter valid data.

Cell/Work Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Cell/Work Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Name of contact available during VBS hours REQUIRED Please fill out this field. Please enter valid data.

Phone Number contact available during VBS. REQUIRED Please fill out this field. Please enter a phone number.

Parish at which your family is registered REQUIRED Please fill out this field. Please enter valid data.

Person responsible for pickup after VBS each day. REQUIRED Please fill out this field. Please enter valid data.

Phone Number of person responsible for pickup after VBS each day REQUIRED Please fill out this field. Please enter a phone number.

Relationship to the child(ren) of the person responsible for pickup after VBS each day. REQUIRED Please fill out this field. Please enter valid data.

Number of Children Attending VBS REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Child's T-shirt Size REQUIRED Small Medium Large X-Large Please fill out this field.
- Please describe any special needs and/or allergies REQUIRED Please fill out this field.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Child's T-shirt Size REQUIRED Small Medium Large X-Large Please fill out this field.
- Please describe any special needs and/or allergies REQUIRED Please fill out this field.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Child's T-shirt Size REQUIRED Small Medium Large X-Large Please fill out this field.
- Please describe any special needs and/or allergies REQUIRED Please fill out this field.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Child's T-shirt Size REQUIRED Small Medium Large X-Large Please fill out this field.
- Please describe any special needs and/or allergies REQUIRED Please fill out this field.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Child's T-shirt Size REQUIRED Small Medium Large X-Large Please fill out this field.
- Please describe any special needs and/or allergies REQUIRED Please fill out this field.
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Child's T-shirt Size REQUIRED Small Medium Large X-Large Please fill out this field.
- Please describe any special needs and/or allergies REQUIRED Please fill out this field.

Do you agree to allow photos of your child(ren) to be used in church postings or church promotional materials (including parish newsletter & parish Facebook page). REQUIRED Yes No Please fill out this field.

By typing my signature I agree that the above information is accurate and true to the best of my knowledge and that I am the legal parent and/or guardian of the children I am registering for St. Ann Parish's VBS.

Parent Signature REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Registration Fee for VBS - $40 per child. REQUIRED 40.0 – One child 80.0 – Two Children 120.0 – Three children 160.0 – Four Children 200.0 – Five children Please fill out this field.

St Ann Roman Catholic Church

"To Grow In Grace Through Jesus Christ"

Child Registration Form