Our Lady of the Blessed Sacrament

Vacation Bible School 2017 Registration Form (one form per child)

When: June 26 – June 30, 2017 Time: 9:30am – 12:30pm Ages: 5 – 10 years old Fee: $55 for first child (includes CD) $50 each additional child

REGISTRATION DEADLINE: June 10, 2017 Camper’s First & Last Name: Grade in Sept: Parent’s Name: Daytime Phone: Address: Parent’s Email: Please Note: Sneakers Only!!! Absolutely no flipflops or crocs may be worn. PARENT VOLUNTEERS ARE NEEDED! PLEASE CHECK AREAS BELOW WHERE YOU CAN HELP OUT ____ Group (Crew) Leader ____ Crew Assistant ____ Imagination Station

____ Snack ____ Recreation ____ Music

TEEN VOLUNTEERS NEEDED – ENTERING 7TH GRADE & OLDER ONLY! CHECK AREAS ON LIST ABOVE WHERE YOU CAN HELP I GIVE___/DO NOT GIVE___ MY PERMISSION TO THE TAKING OF PHOTOGRAPHS, VIDEO AND IMAGES OF MEMBERS OF MY FAMILY BY OLBS FOR USE IN PROMOTIONAL MATERIALS, SHARING WITH THE PARISH COMMUNITY AND USE ON THE PARISH WEBSITE. SIGNED:_________________________ DATE:_______

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Our Lady of the Blessed Sacrament Vacation Bible School Emergency Information Form Please complete one EMERGENCY INFORMATION FORM for Each child. Camper’s First & Last Name: __________________________________________________________________ Address: __________________________________________________________________________________ Home Phone: _____________________________ Cell Phone: ______________________________________ Grade in Sept: _____________ Child’s Age Now:_________________ Date of Birth:_____________________ Mother/Guardian Name: _____________________________ Work/Cell#______________________________ Father/Guardian Name: ______________________________ Work/Cell#______________________________ EMERGENCY/PICK-UP INFORMATION Please list additional adult contacts that could be called during camp hours (9:30am-12:30pm) in the case of an emergency. If you cannot be reached, the individuals listed below are the only individuals authorized to pick up your child in addition to the Parent(s)/Guardian(s) listed. We will not release your child to anyone that is not listed without written permission. 1. Name: _________________________ Relationship: ______________ Phone: ________________________ 2. Name: _________________________ Relationship: ______________ Phone: ________________________ MEDICAL INFORMATION Doctor’s Name: _______________________________________ Phone:______________________________ Please list any allergies (bee stings, foods, medications, etc.) ________________________________________ Are any medications or precautions necessary for the allergy? ______________________________________ Is your child required to take medication or use an inhaler during camp? _______Yes _______No If yes, list: _________________________________________________________________________________ Is there any other information this is important for us to know about your child: ________________________ EMERGENCY MEDICAL CARE AUTHORIZATION: THIS MUST BE SIGNED BY A PARENT In the event that I cannot be reached and an emergency occurs, I do hereby grant my permission and fully authorize Our Lady of the Blessed Sacrament staff and adult volunteers in their best judgment to seek ANY AND ALL EMERGENCY DIAGNOSITC, MEDICAL OR SURGICAL CARE that might be necessary for my son/daughter during Vacation Bible School and do hereby hold Our Lady of the Blessed Sacrament, its staff and adult volunteers harmless from any liability which may occur as a result of their seeking emergency medical care under the provision of this paragraph. ______________________________________ Parent/Guardian Signature (required)

____________________________________ Date signed