A High-Flying Gospel Adventure

Vacation Bible School-2005

Registration Form

Please send this form to the Parish office by June 10^th with payment of $30.00 per child or $75.00 maximum per family. Write checks payable to “St. Columban.” If you register before June 10^th, you will receive a free CD of all the VBS songs we will use this summer! This program only succeeds with volunteers. We do expect all families to volunteer in some way to make this a wonderful experience for the children. If you volunteer to chair a committee or work as a Troupe Leader all week, please deduct $10.00 off your total bill!

Parent(s) Names:_________________________________________________________

Address________________________________________________________________

Home Telephone_______________Cell Phone_______________Work Phone_________

E-MAIL________________________________________________________________

Please sign up at the doors of the gym during VBS for the Friday Night dinner-Please indicate how many will be attending and if you would be able to bring a dessert or side dish.

Child’s Name** Birthdate Grade (Entering Fall, 2005) T-Shirt Size*

________________ ________ P3 P4 K 1 2 3 4 5 YXS YS YM YL AS AM

**Children must be at last three years old by July 1^st and fully potty trained!

*Sizes for T-Shirts-YXS (2-4), YS (6-8) M, 10-12, YL (14-16) Adult S, M, L

We will have trained personnel on staff to provide first aid. If your child will need medication dispensed during VBS (including Epi-pens and over the counter medications, please contact the parish office to obtain the proper forms. In an unlikely event of an emergency we will attempt to contact the parents at the phone numbers listed above. If we are unable to contact you, we will then try to reach your emergency contact. In the event we are not able to contact you or your contact, by signing the form below you are giving us the authority to seek, obtain and approve any medical treatment for the child named above which in our judgment is necessary for the health and well being of said children during the attendance at St. Columban’s VBS. All costs occurred are the responsibility of the parent/ guardian.

FACTS CONCERNING MEDICAL HiSTORY-allegies, diseases, medical condition

____________________________________________________________________________________________________________________________________________________________________________

Parent’s signature_____________________________________________________

Emergency Contact___________________________________________phone #_____________________