VBS 2023 Camper Registration

VBS 2023 - Camper Registration for Children in Kindergarten (Age 4) through Grade 5

"*" indicates required fields

Family Information

Registered OLM Parishioner?*
Address*

Information - Parent / Guardian

Mother's/Guardian's Name*

Information - Parent / Guardian 2

Father's/Guardian's Name*

Registration for VBS Campers, Kindergarten (Age 4) through Grade 5

Placement of Siblings
Camper Information:*
First Name
Last Name
Date of Birth
Age
Grade Entering in Fall
Gender (M/F)
 
Hit the plus sign (+) to add additional children.

Information, Policies, and Permissions

To best support you and your child(ren), please let us know of any physical limitations, learning challenges, special needs and/or family circumstances (recent separation, divorce, death or illness). Please contact Mary Jo (331-707-5378) prior to the start of VBS so we may learn how to support you in the care of your child(ren)’s needs and growing faith. Thank you!

GENERAL PERMISSIONS

General Permissions Consent*

CODE OF BEHAVIOR

Code of Behavior Consent*

VIDEOS, PHOTOS, AND VIRTUAL PLATFORMS

Videos, Photos, and Virtual Platforms Consent

MEDICAL PERMISSION

Medical Permission Consent*

Medical Information

Our Diocese ask for the information below to assure for child(ren) safety when they are in the care of the parish program.
ALLERGIC TO MEDICATIONS:*
Please type NA if not applicable.
ALLERGIC TO FOOD:*
Please type NA if not applicable.
Please type NA if not applicable.
Please type NA if not applicable.

Medical Insurance Information

Our Diocese ask for the information below to assure for child safety when they are in the care of the parish program.

EMERGENCY CONTACTS

VBS Fees

VBS Fee*
Fees go toward set designs and materials such as, VBS Bible buddies and booklets, Marian holy cards, Imagination Station gizmos, colorful banduras, snacks, and the VBS music digital card (one per household), and for picnic lunch on Friday for the whole family.

After you hit SUBMIT, you will be redirected to the PAYMENT page to make payment by credit/debit card. If you need tuition assistance or would like to submit a check or cash as payment, please contact Karen Schwartz, Family Faith Administrative Assistant, at karens@olmercy.com or 331-707-5369. THANK YOU!
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The parties agree that this document may be electronically signed and that the electronic signatures appearing on this document are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. Transmission via email is not encrypted, so if you are concerned about the security of your sensitive information, please print and fax this form, surface mail it or hand deliver it.

Please click submit when you are finished filling out the form. Thank you!