VBS PARTICIPANT (rising grades K-5) Registration

: Family Information
: PARTICIPANT FORM-- for children rising K- 5th Grade.
Child's Full Name
Street Address:
City:
Zip Code
Date of Birth: MM/DD/YYYY
Child's School Grade for the year 2023-2024
Family e-mail address:
SAtG Registered Member: YesNo
Gender: MaleFemale
: Emergency Information
List Allergies
Medical Conditions/Special Needs
Physician's Name & Phone #
: Emergency Contact #1
First & Last Name
Relationship
Phone Number
: Emergency Contact #2
First & Last Name
Relationship
Phone Number
My child, _________________________________, has permission to attend Vacation Bible School at St. Albert the Great Parish. I will drop off my child at St Albert the Great each day, and will pick them back up. I agree on behalf of myself and my child’s other parent, ____________________, my child or our heirs, successors and assigns, to hold harmless St. Albert the Great Parish, The Dioceses of Knoxville, its officers, directors and agents, the Archdiocese of Louisville, chaperones or representatives associated with the event, arising from or in conjunction with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the Diocese of Knoxville, Archdiocese of Louisville, chaperones or representatives associated with the event for reasonable attorney fee and expenses arising in connection therewith. In the event of an emergency, I hearby give permission to treat and transport my child to the hospital for emergency medical treatment. I wished to be advised prior to any further treatment by hospital or doctor.
Type Name and Date here for Electronic Signature:

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VBS PARTICIPANT (rising grades K-5) Registration

Family Information

PARTICIPANT FORM-- for children rising K- 5th Grade.

Emergency Information

Emergency Contact #1

Emergency Contact #2

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