St. John XXIII VBS: OPERATION OVERBOARD: Dare to Go Deep with God!

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REGISTRATION FORM

Thank you for showing interest in our program!!!

Our VBS is open to children age 4 (by 6/12/23) to 6th grade
and will run June 12 - 16, 2023 from 9:00 AM to 12:00 Noon.

Registration Fee: $20 per camper ($50 limit per family)

Scholarships are available.

To Register Online follow these steps:
STEP ONE: Complete the form below
STEP TWO: Submit Payment

PLEASE READ: Please be sure to fill out this registration form to the best of your knowledge. You may submit this form for up to three (3) children. If you are registering more than three children, you will have to complete this form again.

Submitting this form does not guarantee enrollment; however, you will be notified if there are any issues with your registration. Enrollment is accepted on a PAID first come, first served basis.

Non-parishioner registrations will be accepted, as room is available, AFTER May 8th.

VBS is limited to the first 75 PAID registrations.

Parent/Guardian Name(s) *

(first and last)

Address *

(Street, Apartment #)

City, State, Zip *

Parent/Guardian Primary Phone Number 1 *

(XXX-XXX-XXXX)

Parent/Guardian Primary Phone Number 2

(XXX-XXX-XXXX), (XXX-XXX-XXXX)

Alternate Phone(s)

(XXX-XXX-XXXX), (XXX-XXX-XXXX)

Email Address(es) *

Emergency Contact Name (NOT a parent/guardian) *

Please do not list a parent/guardian from above. In case of an emergency, a parent/guardian is contacted first. If unable to contact parent/guardian(s), this is who we will contact.

Emergency Contact's Relationship to Child(ren) *

This should not be a parent/guardian.

Emergency Contact's Phone Number *

(XXX-XXX-XXXX)

Is your family registered at St. John XXIII? *

Non-Parishioner registrations will be accepted after May 8th.

Yes

How many children are you registering at this time today? *

(This online form is limited to a maximum 3 children of one family. For more than 3 children, or for more than one family, you must complete this online form a second time.)

Required

First Child's Name *

(first and last)

First Child's Age *

First Child's Birthdate *

(MM/DD/YYYY)

First Child's Gender *

Male

Female

First Child's Grade in September 2023 *

First Child's School in September 2023 *

First Child's Special Needs: *

(medical, learning, or physical conditions or ailments, etc. If none, enter "none")

Do you have a Second Child to Register? *

yes

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