Totally Catholic Vacation Bible School
Child Registration Form
June 12-16, 2017 / 9:30 am – 12:30 pm
For children 5 years old by June 1, 2017 through those
entering 5th grade in the fall
Fees:
$35 per child before May 22 (or until full)
Families with 3 or more children: 3rd child in a family: $15; 4th child or more: $10 per registration
Please make checks payable to: St. Edward and list “VBS” under memo section.
St. Edward Catholic Community | 2601 Spring Stuebner Road, Spring, Texas 77389
Co-Coordinators: Jackie Sheeren, Mary Wilmot, Amy Auzenne
Contact Jackie at [email protected] for more information.
Name _________________________________________________
Date of Birth _____________________________________
Grade in 2016-17__________________________________
Sex ________________________________________________
Home Address ________________________________________________________________________________________________
City/Zip ________________________________________________________________________________________________________
Home Phone ________________________________________
Cell/Alt. Phone __________________________________
Parent(s)/Guardian(s) ______________________________________________________________________________________
Email(s) ________________________________________________________________________________________________________
T-Shirt Size:
Child Small
Adult Small
Child Medium
Adult Medium
Adult Large
Child Large
Adult XL
Consent and Liability Waiver
I (name of parent/guardian) _______________________, grant permission for my child, (child’s name)
________________________________, to participate in Totally Catholic VBS to be held June 12-16, 207, 9:30 am-12:30
pm, at St. Edward Catholic Community.
I agree on behalf of myself, my child’s other parent if known or living (name of parent),
________________________________, my child named herein, or our heirs, successors, and assigns and defend the
Archdiocese of Galveston-Houston, St. Edward Catholic Community (its pastor, DRE, CRE, VBS coordinators,
other agents, etc.) or representatives associated with scheduled activity unless the parties involved were
careless or negligent.
(Please see other side.)
In signing this form, I certify that all information contained herein is true and accurate to the best of my
knowledge. I also give release for my child to be photographed and for this photograph to be used
for the promotion of the parish. If you do not wish for your child’s photo to be used, you must
submit this in writing to the Director of Religious Education.
Signature (Parent/Guardian) _____________________________________________________ Date ___________________
Medical/Allergy Information
Please list any food allergies/medical information (histories, medications, etc.) that you would like St.
Edward’s Totally Catholic VBS to be aware of:
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Would you like us to place your child in a group for children with special learning needs?
Select one: Yes ____________ No ____________
If yes, please explain:
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Pick-Up Information
Please list any other adults, other than legal guardians, who may pick up/drop off your child(ren) during the
week of VBS:
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Parents and teens (grades 6-12)! Are you interested in volunteering this year? If so, please list names and
preference areas (such as: group leader/assistant, station leader/assistant, Pre-K program, snack crew, setup, clean up, decorations, etc.) and a VBS coordinator will contact you with more information and meeting
times:
Name(s):____________________________________________________________________________________________________________________
For Adults ages 18+: Are you Virtus trained? Yes ____________ No ____________