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Precious Blood VBS 2019 Participant Registration Form

Last day of Registration: july 5, 2019

Parent's Information

Name

First Name

Last Name

Mobile Phone

(###)

###

####

Home Phone

(###)

###

####

Alternate Emergency Contact Information

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Child Information

Name (Child #1)

First Name

Last Name

Gender (Child #1)

Male

Female

Date of Birth (Child #1)

YYYY

BC Care Card Number (Child #1)

Allergies/Dietary Restrictions/Medical Conditions/Medication (Child #1)

Does this child require any type of additional support? (Child #1)

Name (Child #2)

First Name

Last Name

Gender (Child #2)

Male

Female

Date of Birth (Child #2)

YYYY

BC Care Card Number (Child #2)

Allergies/Dietary Restrictions/Medical Conditions/Medication (Child #2)

Does this child require any type of additional support? (Child #2)

Name (Child #3)

First Name

Last Name

Gender (Child #3)

Male

Female

Date of Birth (Child #3)

YYYY

BC Care Card Number (Child #3)

Allergies/Dietary Restrictions/Medical Conditions/Medication (Child #3)

Does this child require any type of additional support? (Child #3)

Name (Child #4)

First Name

Last Name

Gender (Child #4)

Male

Female

Date of Birth (Child #4)

YYYY

BC Care Card Number (Child #4)

Allergies/Dietary Restrictions/Medical Conditions/Medication (Child #4)

Does this child require any type of additional support? (Child #4)

Terms and Conditions:

By submitting this registration, I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in the VBS and that I will be notified as soon as possible in the event of an emergency. In the case of a sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself of other legal guardian(s) cannot be reached. I hereby do release and forever discharge this Diocese and Parish from all manners of actions, claims which I or the child named above shall or may have for any reason, arising during my child's attendance of the VBS. Unless other written instruction is submitted, I also consent to allowing my child's image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of Parish VBS programs. Any other use will require your further consent.

I understand and agree.

Precious Blood VBS 2019 Participant Registration Form

Last day of Registration: july 5, 2019

Absentee Form

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