2022 VBS Registration Form

Child's Name(Required)

First Last

Child's Grade in Fall 2022(Required)

Child's Gender(Required)

Child's T-Shirt Size(Required)

Medical/Dietary Needs(Required)

Please put N/A if none

Do you need to register another child?

How many additional children do you need to register?

Please enter a number from 1 to 4.

Name (Child 2)(Required)

First Last

Child's Grade in Fall 2022 (Child 2)(Required)

Gender (Child 2)(Required)

T-Shirt Size (Child 2)(Required)

Medical/Dietary Needs for Child 2(Required)

Please put N/A if none

Name (Child 3)(Required)

First Last

Child's Grade in Fall 2022 (Child 3)(Required)

Gender (Child 3)(Required)

T-Shirt Size (Child 3)(Required)

Medical/Dietary Needs for Child 3(Required)

Please put N/A if none

Name (Child 4)(Required)

First Last

Child's Grade in Fall 2022 (Child 4)(Required)

Gender (Child 4)(Required)

T-Shirt Size (Child 4)(Required)

Medical/Dietary Needs for Child 4(Required)

Please put N/A if none

Name (Child 5)(Required)

First Last

Child's Grade in Fall 2022 (Child 5)(Required)

Gender (Child 5)(Required)

T-Shirt Size (Child 5)(Required)

Medical/Dietary Needs for Child 5(Required)

Please put N/A if none

Parent's Name(Required)

First Last

Parent's Email(Required)

Parent's Phone(Required)

Emergency Contact (for VBS week)(Required)

First Last

Cell Phone Number(Required)

Relationship to Child(Required)

Anything else we should know?(Required)

Please put N/A if none

Would you like to purchase an OPTIONAL CD of the music from VBS week for $7.00?(Required)

If you select YES, please be sure to add $7.00 to your VBS fee when paying.

Your name below is acknowledgement of and agreement to the below information.(Required)

I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge Cat.Chat Productions Inc., the Archdiocese of Atlanta, and St. Clare of Assisi Catholic Church from all manners of actions, claims, which I or the child named above shall or may have for any reason, arising during my child's attendance of the VBS.

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