Vacation Bible School Registration Form - St. Albert the Great ...

ST. ALBERT THE GREAT
VACATION BIBLE SCHOOL
July 29 – August 2, 2013
Office (937) 298-2402/Fax (937) 293-1848/www.stalbertthegreat.net
AUGUST 1 – 5, 2011
Guarantee your child’s spot and register by July 8, 2013
PLEASE NOTE: CHILDREN MUST BE 4 YEARS OLD THROUGH 10 YEARS OLD OR HAVE
COMPLETED GRADE 4. FEE $30.00 PER CHILD
FAMILY NAME______________________________PHONE_______________CELL# _________________
ADDRESS________________________________________________________________________________
CITY/ZIP____________________________E-MAIL______________________________________________
PARENT’S NAME/S________________________________________________________________________
STUDENT(S) NAME AGE BIRTH DATE GRADE
(AS OF SEPTEMBER 2013)
1. ________________________ _____ _____________ ________
2. ________________________ _____ _____________ ________
3. ________________________ _____ _____________ ________
4. ________________________ _____ _____________ ________
MEDICAL/EMERGENCY INFORMATION
DOES YOUR CHILD HAVE ANY UNUSUAL HEALTH OR SPECIAL NEEDS CONDITIONS?
(E.g. allergies, asthma, bee sting allergy, learning disability, physical handicap, etc.)
YES ____ NO _____ IF YES, PLEASE INDICATE: _____________________________________________
IS YOUR CHILD CURRENTLY TAKING MEDICATION?
YES ____ NO ____ MEDICATION/DOSAGE: _________________________________________________
ALTERNATIVE PERSONS TO BE NOTIFIED WHEN PARENTS CANNOT BE REACHED:
1. ________________________________________________ PHONE ___________________
2. ________________________________________________ PHONE ___________________
PARISH MEDIA PUBLICATION PERMISSION
I hereby give St. Albert the Great the right to use the above listed child/children’s name, photograph and class
projects for reproduction on parish media publications. This material will only be used for activities related to
St. Albert the Great Vacation Bible School. _____________________________________________________
(Parent/Guardian Signature)
Permission Denied: _______________________________________________________
(Parent/Guardian Signature)
OFFICE USE ONLY
Date Received ____________ Check # _____________ Date Posted __________________
Reg form.c(Kim/vbs)
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EMERGENCY MEDICAL CONSENT
In the event reasonable attempts to contact me, parent at home, _______________ (phone),
mother at work __________________ (phone), father at work _________________, (phone)
other parent or guardian _____________________ (phone).
I hereby give my consent for
(1) The administration of any treatment deemed necessary by
Dr. ______________________________________________Phone ________________or
Dentist ___________________________________________Phone __________________ or in the event the
designated preferred physician or dentist is not available, by
(2) The transfer of the child to ___________________________________________________
(preferred hospital)
This authorization does not cover major surgery unless the medical opinions of two licensed physicians or
dentists, concurring in the necessity for such surgery, are obtained prior to the performance of surgery.
DATE ________________ _____________________________________________________
Signature of parent/guardian
CONSENT REFUSED
I do not give my consent for emergency medical treatment of my child. In the event of illness or injury
requiring emergency treatment, I wish the school authorities to take no action or to:
______________________________________________________________________________
______________________________________________________________________________
DATE _______________
_____________________________________________________
Signature of parent/guardian
VOLUNTEER INTEREST SHEET
___ Main Planning Team - (Coordinator) of a VBS area:
crafts, snack, games, prayer or drama
___ Outreach Team - (Mission Focus) coordinate donations
from the VBS students each day.
___ Snack Team – assist with snack
___ Arts & Crafts Team – assist with craft
___ Student Helper – (incoming 6 th gr. & older)
assist teacher/help coordinators
___ Home Help – cutting, putting crafts together, etc.
___ Music Team – play an instrument, sing
and teach songs to children
___ Game Team – assist with games
___ Child Care Team – nursery care for
teacher’s children
___ Teacher – 16yrs. or older, no planning
required. Lead students in small
groups
___ Photo Team – take photo/video, put
together presentation
All volunteers 18 yrs. and older must have been fingerprinted and had the Child Protection Class no later
than June 27, 2013. Please call the Religious Education Office if you have any questions 298-2402.
Reg form.c(Kim/vbs)
(over)