HOLY REDEEMER RELIGIOUS EDUCATION
VACATION BIBLE SCHOOL REGISTRATION
Monday June 24 – Friday, June 28, 2019
**(One form PER child, please)
*Student First Name: _________________________________________________________    
*Student Last Name:  _________________________________________________________    
 			Nick Name: _______________________________________________                
Age:  ___________    					   Gender (circle):  Male  /  Female                 
ENTERING GRADE: ____________________________             
Home Parish (if applicable): ____________________________________________________________
Allergies: ___________________________________________________________________________
Medical Issues or Special Needs: ________________________________________________________    
It would be nice if my child is placed in same group as (child's name): __________________________ 
  
*Parents Name: _____________________________________________________________________
*Address: _________________________________________________________________________________ 
*City:______________________________________________________________________________  
*State:_________________________________________________*Zip_____________________________

*Email(s): __________________________________________________________________________
*Home Phone Number:  ________________________________________________________     
*Cell Phone Number:    _________________________________________________________     
Work or Other Phone Number: _____________________________________________________

Emergency Contact: __________________________________________________________ 
Emergency Phone: ___________________________________________________________
Alternate Pickup Name: _______________________________________________________
Alternate Pickup Phone: _______________________________________________________   

General Information: _________________________________________________________            

Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Photo Release: I hereby grant the above named parish permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

Permission to Attend: I give permission for my child (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church, and that all registration information will be removed from the hosting site by December 31 of this year.

__________________________________________________________  ___________________________ 
Parent Signature							 Date