VBS 2022 Camper Registration

VBS 2022 - Camper Registration for Children in Kindergarten (Age 4) through Grade 5

  • Information - Parent / Guardian

  • Information - Parent / Guardian 2

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

  • First NameLast NameDate of BirthAgeGrade Ent.Gender (M/F) 
    Hit the plus sign to add additional children.
  • Placement of Siblings

    If applicable, please select yes or no.
  • Comments or Questions

  • 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

  • VIDEOS, PHOTOS, AND VIRTUAL PLATFORMS CONSENT

    Videos and/or photos may be taken during this event. This authorization consent constitutes permission to use my child(ren)'s image in video and/or photos which may be used for future promotional efforts including the parish and /or Diocese of Joliet website.
  • CODE OF BEHAVIOR

    INFRACTION OF THESE RULES CAN MEAN IMMEDIATE DISMISSAL WITH NO REFUND.
  • MEDICAL PERMISSION FORM

  • 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.
  • 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

    In the event of an emergency please contact:
  • Information - Emergency Contact 1

  • Information - Emergency Contact 2

  • VBS Fees

    Fees go toward the cost of the magic of VBS such as set designs, and materials for each child, such as, VBS Bible buddies and booklets, Saint holy cards, Imagination Station gizmos, colorful banduras, prepackaged snacks, and the VBS music digital card (one per household), and for picnic food 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 us at maryjot@olmercy.com THANK YOU!
  • 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!