Sacred Heart & St. Athanasius Vocation Bible School

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

2019

Email *

Child's name/Age/Grade: *

Child's name/Age/Grade:

Parent/Guardian #1 Name *

Phone Number *

Ok to Text? *

Email Address *

Parent/Guardian #2 Name

Phone Number

Ok to Text?

Email Address

Home Address *

Name & Phone of Emergency Contact 1 (Other than parent/guardian) *

Name & Phone of Emergency Contact 2 (Other than parent/guardian) *

I hereby authorize treatment for my child(ren) by a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me/my emergency contacts. Reason for which release is intended: Vocation Bible School 2019. *

Yes, I grant permission.

No, I DO NOT grant permission.

Acknowledgment of Receipt of Notice Privacy Rights *

I authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility.This authorization is completed and agreed to of my own free will with the sole purpose of authorizing medical treatment deemed necessary and appropriate by the treating physician.

I DO NOT authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility.

Name/Med Conditions/Allergies: *

Write "none" if your child(ren) does not have any medical conditions or allergies.

Family Physician's Phone and Address *

Health Insurance Data (Company, Policy, Group, Contract, etc.) *

Please indicate which program your child(ren) will attend: *

Sacred Heart in Gladwin, 9:30 a.m. - 12 noon

St. Athanasius in Harrison, 1 p.m. - 3:30 p.m.

Please indicate the days your child(ren) will attend: *

Monday, July 8, Jesus Calls Us to a Vocation

Tuesday, July 9, Magnificent Marriage

Wednesday, July 10, Powerful Priesthood

Thursday, July 11, Radiant Religious Life

Friday, July 12, Sent Forth on Mission!

Required

Sacred Heart and St Athanasius Parishes will not photograph, videotape and/or voice-tape individuals in its programs without consent. This section allows you to give permission for your child/children to be photographed, videotaped and/or voice-taped by school personnel and/or area news reporters. Photographs, videotapes and/or voice-tapes, when consented to, will only be used for the purposes you specify below. *

I grant permission for the personnel of Sacred Heart and St. Athanasius Parishes to photograph, videotape and/or voice-tape my child/children (or allow area news reporters to do the same) for purposes of:

Public Information for Promotion of Parish Programs (Social media sites, newspapers, etc.)

In-Parish Purposes Only (Bulletin boards, bulletin, etc.)

I DO NOT grant permission for the personnel of Sacred Heart and St. Athanasius Parishes to photograph, videotape and/or voicetape my child/children (or allow area news reporters to do the same) for any purposes.

Required

I can help with this year's VBS! *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms