- Our Lady of Lourdes Catholic Church

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2024 VBS PARTICIPANT REGISTRATION
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  Number of Children Attending REQUIRED Please fill out this field.
  
  Child Name 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.
  
  Age / 2024-2025 grade REQUIRED Please fill out this field.
  
  Please list any dietary restrictions, medical conditions, or other considerations we should be aware of.
  
  Registration Fee15.0
  
  Child Name 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.
  
  Age / 2024-2025 grade REQUIRED Please fill out this field.
  
  Please list any dietary restrictions, medical conditions, or other considerations we should be aware of.
  
  Registration Fee15.0
  
  Child Name 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.
  
  Age / 2024-2025 grade REQUIRED Please fill out this field.
  
  Please list any dietary restrictions, medical conditions, or other considerations we should be aware of.
  
  Registration Fee15.0
  
  Child Name 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.
  
  Age / 2024-2025 grade REQUIRED Please fill out this field.
  
  Please list any dietary restrictions, medical conditions, or other considerations we should be aware of.
  
  Registration Fee15.0
  
  Child Name 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age / 2024-2025 grade REQUIRED Please fill out this field.
  
  Please list any dietary restrictions, medical conditions, or other considerations we should be aware of.
  
  Registration Fee15.0
  
  Child Name 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age / 2024-2025 grade REQUIRED Please fill out this field.
  
  Please list any dietary restrictions, medical conditions, or other considerations we should be aware of.
  
  Registration Fee15.0
  
  Parent
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Emergency Contact
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Relationship REQUIRED Please fill out this field.
  
  Parental Consent
  
  I am the parent or legal guardian of the named participants and grant permission for participation in VBS at Our Lady of Lourdes.
  I understand that reasonable precautions will be taken to safeguard the health and wellbeing of the participants in the VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or accident, I authorize and consent the VBS team or other associated staff or volunteers of Our Lady of Lourdes Catholic Church to obtain medical care from a licensed physician, hospital, or medical clinic for my child in the event that I or the listed emergency contact cannot be reached.
  I will not hold liable Our Lady of Lourdes or the Catholic Diocese of Columbus for any accidents or injuries arising from my child's participation in VBS.
  I understand that photographs and videos taken during VBS may be used by the Diocese of Columbus and Our Lady of Lourdes. If I do not want my child's image to be recorded, I will contact Anne Daniel in writing.
  
  I Agree Please select this field.
  
  Total:
  
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