Vacation Bible School

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First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
- Number of Students REQUIRED Please fill out this field.
- Student 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.
  - Nickname Please enter valid data.
  - Gender REQUIRED Male Female Please fill out this field.
  - Grade in the Fall of 2023
  - T-Shirt Size REQUIRED Please fill out this field.
  - Does your child have any specific needs? REQUIRED Yes No Please fill out this field.
  - If yes, please explain:
  - Registration Fee25.0
- Student 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.
  - Nickname Please enter valid data.
  - Gender REQUIRED Male Female Please fill out this field.
  - Grade in the Fall of 2023
  - T-Shirt Size REQUIRED Please fill out this field.
  - Does your child have any specific needs? REQUIRED Yes No Please fill out this field.
  - If yes, please explain:
  - Registration Fee25.0
- Student 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.
  - Nickname Please enter valid data.
  - Gender REQUIRED Male Female Please fill out this field.
  - Grade in the Fall of 2023
  - T-Shirt Size REQUIRED Please fill out this field.
  - Does your child have any specific needs? REQUIRED Yes No Please fill out this field.
  - If yes, please explain:
  - Registration Fee25.0
- Student 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.
  - Nickname Please enter valid data.
  - Gender REQUIRED Male Female Please fill out this field.
  - Grade in the Fall of 2023
  - T-Shirt Size REQUIRED Please fill out this field.
  - Does your child have any specific needs? REQUIRED Yes No Please fill out this field.
  - If yes, please explain:
  - Registration Fee25.0
Parents Information
- Father 1st and Last Name Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mother 1st and Last Name Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Streed Address Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Agree to: PARENTAL/GUARDIAN CONSENT FORM AND LIABILITY WAIVER
  
  As parent and/or legal guardian, I remain legally responsible for any personal
  actions taken by the above named minor (“participant”). I agree on behalf of
  myself, my child named herein, or our heirs, successors, and assigns, to hold
  harmless and defend The Cathedral of St. John the Evangelist Roman Catholic
  Church, and Cathedral Carmel School, its officers, directors, employees and agents,
  and the Diocese of Lafayette, its employees and agents, chaperones, or
  representatives associated with the event, from any claim arising from or in
  connection with my child attending the event or in connection with any illness or
  injury (including death) or cost of medical treatment in connection therewith,
  and I agree to compensate the parish, its officers, directors and agents, and the Diocese of Lafayette, its employees and agents and chaperones, or
  representative associated with the event for reasonable attorney’s fees and expenses
  which may incur in any action brought against them as a result of such injury or
  damage, unless such claim arises from the negligence of the parish/diocese.
  
  Agree To: MEDICAL MATTERS:
  
  I hereby warrant that to the best of my knowledge, my
  child is in good health, and I assume all responsibility for the health of my child.
  Medications: My child is taking medication at present. My child will bring all
  such Medications necessary, and such medications will be well-labeled.
  Names of medications and concise directions for seeing that the child takes such
  medications, including dosage and frequency of dosage, are as follows:
  
  Agree To: Emergency Medical Treatment:
  
  In the event of an emergency, I hereby give
  permission to transport my child to a hospital for emergency medical or surgical
  treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
  
  Agree to: Photo Release:
  
  Photographs will be taken during the week of camp. Photos may
  appear in church bulletin and/or church website.
  I hereby give permission for my child’s photo to possibly be used in church publications.
  I Agree Please select this field.

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