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Vacation Bible School Registration

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  VACATION BIBLE SCHOOL DISCLOSURE & PERMISSION
  
  I give my child/children permission to participate in the Vacation Bible Camp, sponsored by Christ the Divine Shepherd Parish (at the Saint Bernadette site in Monroeville) from July 20 to July 24, 2026. I understand that reasonable precautions will be taken to safeguard the health and well-being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the event of an accident or serious illness, I authorize medical care for my child. I understand that as a participant, my child may be photographed or videotaped during normal VBS activities and these photos/videos may be used in parish presentations, posters, flyers, website, or other publications. If I do not want my child photographed or videotaped, I will notify the VBS director in writing. I understand that the child listed above is to be dropped off and picked up by the person(s) I indicate below. I understand that I am responsible for checking in and checking out my child daily. I understand that if my child brings personal items to VBS, the parish and VBS staff are not responsible for those items. I understand that if my child does not comply with the rules of VBS program, they may be sent home. By signing this form I am in agreement with the above and give my child/children to participate in Christ the Divine Shepherd Parish Vacation Bible School. Submission of this form online may be accepted as my electronic signature by clicking "I agree".
  I Agree Please select this field.
  
  How many will you be registering for Vacation Bible School? REQUIRED Please fill out this field.
  
  Child Information 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Age REQUIRED Please fill out this field.
  
  Grade Completed? REQUIRED Please fill out this field.
  
  Please list any food allergies or allergy medication
  
  Health Insurance # Please enter valid data.
  
  Child Information 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Age REQUIRED Please fill out this field.
  
  Grade Completed? REQUIRED Please fill out this field.
  
  Please list any food allergies or allergy medication
  
  Health Insurance # Please enter valid data.
  
  Child Information 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Age REQUIRED Please fill out this field.
  
  Grade Completed? REQUIRED Please fill out this field.
  
  Please list any food allergies or allergy medication
  
  Health Insurance # Please enter valid data.
  
  Child Information 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Age REQUIRED Please fill out this field.
  
  Grade Completed? REQUIRED Please fill out this field.
  
  Please list any food allergies or allergy medication
  
  Health Insurance # Please enter valid data.
  
  Parent or Guardian Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Relationship to Camper Please enter valid data.
  
  Total:
  
  Submit
  
  Proceed to Payment

CHRIST THE DIVINE SHEPHERD PARISH

Penn Hills / Pitcairn / Monroeville

Vacation Bible School Registration