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VBS Registration Form

- Faith Formation
  - For Youth
    
    Children (K-8)
    
    Vacation Bible School
    
    VBS Registration Form
    
    The Mass Box
    
    Youth (High School)
  - For Adults
    
    Adult
    Becoming Catholic (RCIA)
  - Registration Forms
    
    Registration Forms
  - Resources
    
    FORMED

Fee: $35.00 for 1 child; $60.00 for 2 or more/ AFTER May 19 $40 PER CHILD

Fee includes one CD per family & covers supplies

Complete One Form per Child
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- 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.
- Gender REQUIRED Please fill out this field.
- Child's Age REQUIRED Please fill out this field. Please enter an integer (number).
- Date of Birth: REQUIRED Please fill out this field. Please enter a date.
- Grade Completed as of June 18 REQUIRED Please fill out this field.
- Parent/ Guardian Name (s)
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  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.
- Home 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.
- Emergency Contact Name
  (other than parents)
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Relationship to child: REQUIRED Please fill out this field. Please enter valid data.
- Home Parish: REQUIRED Please fill out this field. Please enter valid data.
- The children will perform VBS songs at Mass 6/30-7/1. Please choose the Mass you will attend: REQUIRED Saturday 5:30 pm Sunday 8:15 am Sunday 10:30 am Please fill out this field.
- If your child would like to be with a friend, please list the name of your child and friend’s name. They need to be close in age/grade and we cannot guarantee they will be together: Please enter valid data.
- Holy Family VBS Release 2019
  
  Parish: Church of the Holy Family
  Phone: 757- 481-5702
  Address: 1279 North Great Neck Road
  City: Virginia Beach       Zip: 23454
  Type of Event: VBS
  Destination: Church of the Holy Family
  Individual in Charge: Tiffany Watson/Adult Volunteers
  Transportation: Parents drop off and pick up children at the parish
  Dates of Trip: June 24-28, 2019
- Does your child have any allergies? REQUIRED Please fill out this field.
- Details Please enter valid data.
- Is your child taking any medication? REQUIRED Please fill out this field.
- Details Please enter valid data.
- Is there any other physical or emotional condition of which we need to be aware? REQUIRED Please fill out this field.
- Please explain: Please enter valid data.
- 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 the Catholic Diocese of Richmond, the Church of the Holy Family, their employees and agents, chaperons, or representatives associated with the 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 and/or Church of the Holy Family, their employees and agents and chaperons, 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 and/or Church of the Holy Family.
  
  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 the Diocese of Richmond and/or the Church of the Holy Family responsible for authorizing any medical treatment beyond necessary transportation to the hospital.
  
  I Agree Please select this field.
- By checking this box you are stating and agreeing that all the above information is correct and agree to the terms listed above.
- I give permission for pictures and/or video of my child(ren) (named above) engaged in activities related to the Church of the Holy Family to have their pictures posted in 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 Church of the Holy Family assumes you give permission.
- Photo Release REQUIRED Please fill out this field.
Submit