Vacation Bible School Registration

Parent Name*

First Last

Parent Email Primary*

Parent Email Secondary

Parent Primary Phone*

Emergency Contact #1*

First Last

Emergency Contact #1 Phone*

Emergency Contact #2*

First Last

Emergency Contact #2 Phone*

VBS relies on adult helpers to keep registration costs low and ensure success. Please check how you can help (spots filled on a first come/first served basis.)*

Check at least one - you may check more than one.

Are you current with your Archdiocese of Atlanta Safe Environment certification?*

If no or don't know, please contact Cora de Ruiter at cderuiter@judeatl.com or 770-394-3896, ext. 241

Yes
No
I don't know.

Will you need babysitting for younger children?*

Our Nursery welcomes children age 6 mo to 4 years

Yes
No

Please list names and ages here*

Consent*

Saint Jude uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels.
I hereby grant permission for Saint Jude the Apostle to use images and interviews of my child for internal or external communications.

I agree to the media policy

Consent*

I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this Vacation Bible School, and that I will be notified as soon as possible in the event of any emergency. In the case of sickness or an accident, I authorize and give consent to 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 s on/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge the Archdiocese of Atlanta and Saint Jude the Apostle Catholic Church from all manners of actions or claims, which I or my child(ren) shall or may have for any reason, arising from my child's attendance of the VBS program.

I agree to the medical policy.

How many children are you registering for VBS?*

Name Child #1*

First Last

Child #1 Grade Fall 2023*

Child #1 Date of Birth*

Child #1 Gender*

Child #1 T-Shirt Size*

Does Child #1 have any allergies of note for VBS?*

Yes
No

Please explain*

Does Child #1 have any special needs that would affect their time at VBS?*

Yes
No

Please explain*

Child #2

Name Child #2*

First Last

Child #2 Grade Fall 2023*

Child #2 Date of Birth*

Child #2 Gender*

Child #2 T-Shirt Size*

Does Child #2 have any allergies of note for VBS?*

Yes
No

Please explain*

Does Child #2 have any special needs that would affect their time at VBS?*

Yes
No

Please explain*

Child #3

Name Child #3*

First Last

Child #3 Grade Fall 2023*

Child #3 Date of Birth*

Child #3 Gender*

Child #3 T-Shirt Size*

Does Child #3 have any allergies of note for VBS?*

Yes
No

Please explain*

Does Child #3 have any special needs that would affect their time at VBS?*

Yes
No

Please explain*

Vacation Bible School

Child #2

Child #3

Location

Info