VBS 2025

Child #1's Name:

Child #2's Name:

Child #3's Name

Child #1's Age

Child #2's Age

Child #3's Age

Child #1's last grade completed

Child #2's last grade completed

Child #3's last grade completed

Parent #1:

Phone:

Parent #2:

Phone:

Address:

State:

ZIP:

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We will be taking pictures so the children can see themselves playing at the end of the day.

Do we have permission to post pictures on St. Mary's Facebook page or to use as advertisement for next year if necessary?

New Field

Yes, you have my permission

No, you Do Not have my permission

Parent Signature

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PLEASE LIST ANY FOOD ALLERGIES

Allergies to food or medication or any other medical conditions:

In case of emergency contact:

Relationship to child:

Phone #: