Vacation Bible School Registration Form

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Complete the form below to register your child for Vacation Bible School at Holy Name of Mary School. The program is available for students entering Pre-K through Grade 4 and will run from 9 AM-12 PM on July 25 - 29, 2022.

Please submit the registration fee of $100 (cash or check) to the main office by July 10, 2022. Checks can be made out to Holy Name of Mary School.

Child's Name *

Child's Grade (as of September 2022) *

Parent/Guardian Name *

Parent/Guardian Email Address *

Parent/Guardian Phone Number *

Emergency Contact #1 *

Emergency Contact #1 Phone Number *

Emergency Contact #2 *

Emergency Contact #2 Phone Number *

Does your child have any allergies? *

Yes

Describe any allergies below.

Does your child take any medications regularly? *

Yes

Describe any medications below.

Does your child have any special medical conditions we should be aware of? *

Yes

Describe any special medical conditions below.

I understand that there will be no nurse on site during camp hours. I authorize the camp staff members to provide the medication listed above in case of an emergency. *

I understand that no nurse will be on site and grant permission for emergency medical treatment of my child if needed.

I understand that the payment of $100 must be submitted to the main office by July 10, 2022. *

I agree to pay the camp fee by July 10, 2022.

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