VBS 2019 Join us June 11-14 (Tuesday - Friday) from 9:00 a.m. - noon daily at St. James Parish Center for a fun & faith-filled week of Vacation Bible School! The theme is Roar- God is Good! We hope your child(ren) come and experience God's Word. Registration is open to all children who are entering PreK-4 in the fall (must be 4 by 9/1/19 and potty trained) through those entering 5th grade in the fall of 2019. Cost is $30 per child. All participants will be placed in mixed-age groups, so families can stay together. This allows for easy drop-off and pick-up. We are unable to honor friend requests and encourage all participants to make a new friends this summer during VBS. Please fill out this form to register your child(ren) for VBS. Walk-in's will NOT be accepted. You must be registered by May 17, 2019 or until we are full. Last year we filled up quickly, so register early! Your registration will not be complete until payment has been received. You can pay on-line within the registration form. Registration confirmations will be sent to you via the email address you provide. Thank you!Family InformationParent/Guardian Name* First Last Family Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address* **Please make sure the email address is typed correctly. This is how we will communicate with you prior and during VBS.**Home Phone*Cell Phone*Additional Cell PhoneWhat is the best number to reach you at?*Cell PhoneHome PhoneAdditional Cell PhoneChild InformationChild(ren) - Please add all your children in this form, please do not fill out a separate registration form. Name (child 1) Gender (child 1) Grade Entering (child 1) Date of Birth (child 1) Allergies/Pertinent Medical Information (child 1) Does your child need additional assistance to participate in VBS (child1)? Edit Delete There are no Entries. Add Entry VolunteeringWould you or your child (entering 6th grade or older) be interested in Voluteering?YESNOIf you select "YES" you will be contacted.Emergency ContactsEmergency Contact Name (Not parent/guardian)* First Last Emergency Contact Phone*Permission to use photos of child(ren) in Parish media*YESNOThis gives us permission to use your childs photo in the following media outlets....bulletin, website, facebook page and photo slideshowsRegistration Fee*1 Child - $302 Children - $603 Children or more - $90I am an adult volunteer for the entire weekI will pay my fee via cash or check to the Parish OfficeTotal $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Signature*THIS DIGITAL SIGNATURE SIGNIFIES YOUR ACCEPTANCE OF REGISTRATION FEES ($30 for each child or $90 for 3 or more children) AND EMERGENCY CONSENT. EMERGENCY CONSENT: If the parent/guardians or emergency contacts cannot be reached in case of serious injury or illness, I authorize the VBS Program to take such emergency action as may be deemed necessary, including the transportation of the minor(s) to a hospital or medical center. As a parent (or guardian), I do herewith authorize the treatment by a qualified and licensed medical doctor of the following minor(s) in the event of a medical emergency that, in the opinion of the attending physician, may endanger his/her life, cause disfigurement or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me. Child InformationName (child 1)* First Last Gender (child 1)*MaleFemaleGrade Entering (child 1)*4 Year Old (by 9/1/19)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Gradeschool grade entering fall of 2019Date of Birth (child 1)* MM DD YYYY Allergies/Pertinent Medical Information (child 1)Does your child need additional assistance to participate in VBS (child1)?*NoYesVBS is inclusive of all children. To better serve our participants, please indicate if your child will need additional assistance to actively participate in VBS. We are able to provide 1:1 teen mentors. This iframe contains the logic required to handle Ajax powered Gravity Forms.