VBS Registration

- Faith Formation

Scuba VBS Registration

Aug 5-9th, 5:30-8PM. Open to all PK4-5th Graders

Please join us as we travel under the sea to explore God's many wonders!
All are welcome, you do not need to be a Parishioner. Volunteers needed (teen and adult).
Please contact Debbie Gausmann to help.
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- Parent Name
  
  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.
  
  Is your family registered in the Parish? REQUIRED Yes No Please fill out this field.
- Emergency Contact
- Name (First, Last) 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.
- Number of Children Registering REQUIRED
  Input the number of children you will be registering and the form will replicate that number.
  Please fill out this field.
  
  Child 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 REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade for 24/25 School Year REQUIRED Please fill out this field.
  
  Does your child have any food or insect allergies? REQUIRED Please fill out this field.
  
  Child 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 REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade for 24/25 School Year REQUIRED Please fill out this field.
  
  Does your child have any food or insect allergies? REQUIRED Please fill out this field.
  
  Child 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 REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade for 24/25 School Year REQUIRED Please fill out this field.
  
  Does your child have any food or insect allergies? REQUIRED Please fill out this field.
  
  Child 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 REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade for 24/25 School Year REQUIRED Please fill out this field.
  
  Does your child have any food or insect allergies? REQUIRED Please fill out this field.
  
  Child 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 REQUIRED Please fill out this field. Please enter an integer (number).
  
  Grade for 24/25 School Year REQUIRED Please fill out this field.
  
  Does your child have any food or insect allergies? REQUIRED Please fill out this field.
- Release of Liability and Medical
  As parent and/or legal guardian I remain legally responsible for any personal actions taken by the above-named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Kateri Tekakwitha, the Catholic Diocese of Richmond, its employees and agents, chaperones, or representatives associated with this 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 Diocese, its employees and agents and chaperones, or representatives 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 Diocese. 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. In the event of any 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. In the event of an emergency, if you are unable to reach me at the above numbers, I give permission for the noted emergency contact to be notified. I will not hold St. Kateri Tekakwitha and the Diocese of Richmond responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
- I Agree Please select this field.
- Permission for use of Pictures and/ or Videos:
  I give permission for the use of the voice/audio recordings, photographs, video and quotations of my child (named above) engaged in activities related to the parish or Diocesan event posted in St. Kateri Tekakwitha, the Diocese of Richmond publications or websites. Names of participants will not be used without expressed permission from the parent or guardian. If no box is checked below, the Diocese of Richmond assumes you give permission.
- I Agree Please select this field.
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