Kids VBS Registration

Parent First Name REQUIRED Please fill out this field. Please enter valid data.

Parent Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

1st Child - Grade (as of Sept. 2026) REQUIRED Please fill out this field. Please enter valid data.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Gender - Male or Female REQUIRED Please fill out this field. Please enter valid data.

Date of Birth - MM/DD/YYYY REQUIRED Please fill out this field. Please enter valid data.

T-shirt size - please be sure to choose the correct YOUTH or ADULT size below REQUIRED Youth - Small Youth - Medium Youth - Large Youth - XL Adult - Small Adult - Medium Adult - Large Adult - XL Please fill out this field.

2nd Child - Grade (as of Sept. 2026) Please enter valid data.

First Name Please enter valid data.

Last Name Please enter valid data.

Gender - Male or Female Please enter valid data.

Date of Birth - MM/DD/YYYY Please enter valid data.

T-shirt size - please be sure to choose the correct YOUTH or ADULT size below Youth - Small Youth - Medium Youth - Large Youth - XL Adult - Small Adult - Medium Adult - Large Adult - XL

3rd Child - Grade (as of Sept. 2026) Please enter valid data.

First Name Please enter valid data.

Last Name Please enter valid data.

Gender - Male or Female Please enter valid data.

Date of Birth - MM/DD/YYYY Please enter valid data.

T-shirt size - please be sure to choose the correct YOUTH or ADULT size below Youth - Small Youth - Medium Youth - Large Youth - XL Adult - Small Adult - Medium Adult - Large Adult - XL

4th Child - Grade (as of Sept. 2026) Please enter valid data.

First Name Please enter valid data.

Last Name Please enter valid data.

Gender - Male or Female Please enter valid data.

Date of Birth - MM/DD/YYYY Please enter valid data.

T-shirt size - please be sure to choose the correct YOUTH or ADULT size below Youth - Small Youth - Medium Youth - Large Youth - XL Adult - Small Adult - Medium Adult - Large Adult - XL

ADULT VOLUNTEERS - Thank you for joining us; we need your help! REMINDER: If you have a preschool child in the VBS program, you MUST volunteer to help the entire week of VBS. REQUIRED Please fill out this field.

REGISTRATION FOR CHILDREN OF VOLUNTEERS PRESCHOOL AGE

Available ONLY for the adults who are volunteering to work the entire week of VBS - Preschool Children - 3 and 4 year olds

Child's Age Please enter valid data.

Child's Name Please enter valid data.

Gender - Male or Female Please enter valid data.

Date of Birth - MM/DD/YYYY Please enter valid data.

T-shirt size - please be sure to choose the correct YOUTH size below Youth - XS Youth - Small Youth - Medium

Child's Age Please enter valid data.

Child's Name Please enter valid data.

Gender - Male or Female Please enter valid data.

T-shirt size - please be sure to choose the correct YOUTH size below Youth - XS Youth - Small Youth - Medium

Medical Form/Emergency Contact/Photography Release Form

1st Child's First and Last Name, any Medical Conditions, and if they have asthma, any allergies, drug allergies, or routine medications we may need to be aware of during VBS. REQUIRED Please fill out this field.

2nd Child's First and Last Name, any Medical Conditions, and if they have asthma, any allergies, drug allergies, or routine medications we may need to be aware of during VBS.

4th Child's First and Last Name, any Medical Conditions, and if they have asthma, any allergies, drug allergies, or routine medications we may need to be aware of during VBS.

WAIVER/AUTHORIZATION FOR EMERGENCY MEDICAL ATTENTION

I, who by law may do so, authorize the administration of emergency medical treatment for the subject of this release form. I understand that all reasonable safety precautions will be taken during this event. I will not hold St. Mark the Evangelist Catholic Church, members of the staff or volunteers responsible for accidental harm or injury that may occur during this event. I understand that, in the event medical intervention is needed, every attempt will be made to contact the person(s) listed on this form immediately.

I Agree Please select this field.

Parent's full name REQUIRED Please fill out this field. Please enter valid data.

Please include medical provider information/insurance company, policy number below REQUIRED Please fill out this field.

Emergency Contact Name, Phone/Cell Phone and/or Parent Work Phone REQUIRED Please fill out this field.

In case of emergency, person to contact other than parent listed above: (please provide home phone, cell phone, work phone REQUIRED Please fill out this field.

*I understand that various photographs may be taken by St. Mark, the newspaper or other media organizations during this program. I give permission for my child(ren)’s picture to be used at the discretion of the program staff.

Parent Full Name required with date REQUIRED Please fill out this field. Please enter valid data.

IF YOUR CHILD(REN) WILL BE PICKED UP BY SOMEONE OTHER THAN YOURSELF PLEASE LET US KNOW. Name of person picking up your child(ren):

Cell phone number of person picking up your child(ren) (only if applicable) Please enter a phone number.

If you prefer to pay with check or cash, please submit your registration form and come to the parish office to complete your payment.

Total Fees Due: children (PreK-5th Grade) $50.00 each REQUIRED Please fill out this field.