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St Ann Vacation Bible School Registration 2022. Done by Sisters of Mary, Mother of the Eucharist
Event Timing: June 13-17th, 2022. 9:30am-12pm
Event Address: 12648 East D Avenue, Augusta, MI, 49012
Contact us at 269-731-4721 ext. 150 or
bobbyk@stannaugusta.org
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Email
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Your email
Your Name (first and last)
*
Your answer
Your Phone number
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Your answer
Address
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Your answer
Do you have any child volunteers aged 13 and up able to volunteer? Select which days they can volunteer.
No
June 13th Monday 9-noon
June 14th Tuesday 9-noon
June 15th Wednesday 9-noon
June 16th Thursday 9-noon
June 17th Friday 9-noon
What are the the child volunteer's names and ages?
Your answer
Child 1's name (first and last)
Your answer
Child 1's Relationship to you
Your answer
Child 1 is a parishioner?
Yes
No
Clear selection
Child 1's age
5
6
7
8
9
10
11
12
Other:
Clear selection
Child 1's Grade or Equivalent
Your answer
Child 1 Food Allergies
Your answer
Child 1 Special Needs
Your answer
Child 2's name (first and last)
Your answer
Child 2's Relationship to you
Your answer
Child 2 is a parishioner?
Yes
No
Clear selection
Child 2's age
5
6
7
8
9
10
11
12
Other:
Clear selection
Child 2's Grade or Equivalent
Your answer
Child 2 Special Needs
Your answer
Child 2 Food Allergies
Your answer
Child 3's name (first and last)
Your answer
Child 3's Relationship to you
Your answer
Child 3 is a parishioner?
Yes
No
Clear selection
Child 3's age
5
6
7
8
9
10
11
12
Other:
Clear selection
Child 3's Grade or Equivalent
Your answer
Child 3 Special Needs
Your answer
Child 3 Food Allergies
Your answer
Child 4's name (first and last)
Your answer
Child 4's Relationship to you
Your answer
Child 4's age
5
6
7
8
9
10
11
12
Other:
Clear selection
Child 4's Grade or Equivalent
Your answer
Child 4 is a parishioner?
Yes
No
Clear selection
Child 4 Special Needs
Your answer
Child 4 Food Allergies
Your answer
Child 5's name (first and last)
Your answer
Child 5's Relationship to you
Your answer
Child 5's age
5
6
7
8
9
10
11
12
Other:
Clear selection
Child 5 is a parishioner?
Yes
No
Clear selection
Child 5's Grade or Equivalent
Your answer
Child 5 Special Needs
Your answer
Child 5 Food Allergies
Your answer
Emergency Contact 1
Your answer
Emergency Contact 2
Your answer
Emergency Contact 1 Phone Number
Your answer
Emergency Contact 2 Phone Number
Your answer
Family Physician
Your answer
Physician Address
Your answer
List medications, medical allergies, contacts or other pertinent comments
Your answer
Heath Insurance Company
Your answer
Policy
Your answer
Group
Your answer
Contract
Your answer
Authorization: As a parent/guardian, I do hereby authorize the treatment 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. I further authorize the person who presents the minor to sign the acknowledgement of receipt of notice Privacy Rights that may be presented by the physician or health care facility. This digital authorization is completed of my own free will with the sole purpose of of authorizing medical treatment deemed necessary and appropriate by the treating physician.
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I agree
I disagree
N/A
Authorization Date
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MM
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DD
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YYYY
Photo Release: I give permission to publish photos of my child for promotional purposes of future Vacation Bible School programs and other related activities and programs of the parish and the programs and offerings of the Sisters of Mary Mother of the Eucharist. I understand that only my child's first name and last initial with be used if captions are listed with the photos
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I Agree
I Agree, but not even first name is to be used
I Disagree
N/A
Required
Photo Release Date
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MM
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DD
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YYYY
Cost: made payable to "St Ann Church." Give to front office or religious education office, or pay online
https://stannaugusta.org/donate-online
1 child: $50
2 children: $100
3 children: $150
4 children or more: $200
Other:
Clear selection
Do you plan to pay online? If so, go to
https://stannaugusta.org/donate-online
and make payment under "Faith Formation- Youth Faith Formation"
Yes
No
Maybe
Clear selection
Do you have any adult volunteers for the week 9:30-noon? Please list name and phone numbers
*
Your answer
Any Comments here. Longer questions can be sent to
Bobbyk@stannaugusta.org
Your answer
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