Vacation Bible School Registration REGISTRATION IS FULL! – Currently we can only accept children of adult volunteers. VBS Registration Family Last Name(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone(Required)Family Email(Required) Name of parish where you are registered(Required)Note – This may or may not be the parish where you attend regularly, simply where you are registered as a parishioner. This is for informational purposes only; we gladly accept all families from any parish (Catholic or other). Who would you like to register today?(Required) Child Participant (in grades rising K-5) Youth Volunteer (grades rising 6-12) Adult Volunteer How many Child Participants to register?(Required)123456How many Youth Volunteers to register(Required)123How many Adult Volunteers to register(Required)12Adult Volunteer 1Name(Required) First Last Mobile Phone(Required)or home if no mobileEmail(Required) What is preferred section to volunteer?(Required)We will try to accommodate your preference, but this is not guaranteed. No Preference Crafts Drama Gym Kitchen Small Groups T-Shirt Size(Required) Adult S Adult M Adult L Adult XL Adult XXL Sex(Required) Male Female Have you completed Child Protection requirements with the Diocese of Arlington?(Required) Yes No What parish holds your Child Protection compliance information?(Required) Full Legal Name(Required)What is your full name that you completed the diocese child protection training under? First Middle Last Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult Volunteer 2Name(Required) First Last Mobile Phone(Required)or home if no mobileEmail(Required) What is preferred section to volunteer?(Required)We will try to accommodate your preference, but this is not guaranteed. No Preference Crafts Drama Gym Kitchen Small Groups T-Shirt Size(Required) Adult S Adult M Adult L Adult XL Adult XXL Sex(Required) Male Female Have you completed Child Protection requirements with the Diocese of Arlington?(Required) Yes No What parish holds your Child Protection compliance information?(Required) Full Legal Name(Required)What is your full name that you completed the diocese child protection training under? First Middle Last Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child's Parent InformationName(Required) First Last Phone(Required)Email(Required) Relationship(Required)FatherMotherGuardian / OtherAdd second parent information?(Required) Yes No Name(Required) First Last Phone(Required)Email(Required) Relationship(Required)FatherMotherGuardian / OtherEmergency Contact InformationName(Required) First Last Phone(Required)Relationship(Required) Youth Volunteer 1Name(Required) First Last School Grade(Required)Grade youth volunteer will enter in September 20236789101112Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female What is preferred section to volunteer?(Required)We will try to accommodate your preference, but this is not guaranteed. No Preference Crafts Drama Gym Kitchen Small Groups T-Shirt Size(Required) Adult S Adult M Adult L Adult XL Adult XXL Youth Volunteer 2Name(Required) First Last School Grade(Required)Grade youth volunteer will enter in September 20236789101112Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female What is preferred section to volunteer?(Required)We will try to accommodate your preference, but this is not guaranteed. No Preference Crafts Drama Gym Kitchen Small Groups T-Shirt Size(Required) Adult S Adult M Adult L Adult XL Adult XXL Youth Volunteer 3Name(Required) First Last School Grade(Required)Grade youth volunteer will enter in September 20236789101112Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female What is preferred section to volunteer?(Required)We will try to accommodate your preference, but this is not guaranteed. No Preference Crafts Drama Gym Kitchen Small Groups T-Shirt Size(Required) Adult S Adult M Adult L Adult XL Adult XXL Child Participant 1Name(Required) First Last School Grade(Required)Grade youth will enter in September 2023K12345Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female T-Shirt Size(Required) Youth S Youth M Youth L Adult S Child Participant 2Name(Required) First Last School Grade(Required)Grade youth will enter in September 2023K12345Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female T-Shirt Size(Required) Youth S Youth M Youth L Adult S Child Participant 3Name(Required) First Last School Grade(Required)Grade youth will enter in September 2023K12345Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female T-Shirt Size(Required) Youth S Youth M Youth L Adult S Child Participant 4Name(Required) First Last School Grade(Required)Grade youth will enter in September 2023K12345Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female T-Shirt Size(Required) Youth S Youth M Youth L Adult S Child Participant 5Name(Required) First Last School Grade(Required)Grade youth will enter in September 2023K12345Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female T-Shirt Size(Required) Youth S Youth M Youth L Adult S Child Participant 6Name(Required) First Last School Grade(Required)Grade youth will enter in September 2023K12345Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex(Required) Male Female T-Shirt Size(Required) Youth S Youth M Youth L Adult S Medical and Photography InformationMedical Information and Liability Waiver(Required) I agree As the parent of the registered youth(s), I hereby grant permission for my youth to be medically treated in case of sickness or accident. I understand and acknowledge that participation in the activities involves inherent risks of injury to my youth. I agree to indemnify the Parish, Youth Ministers, Volunteers and the Diocese of Arlington for any costs or expenses arising out of my youth’s participation in the activities including the cost of any medical care given my youth or any expenses or fees incurred in any lawsuit arising as a result of any damage or injuries caused by my child in the course of his/her participation in the activity. I further give my consent to that in my absence the above named minor be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above named minor.Photographs I agree I authorize Holy Spirit Catholic Church to use my youth’s picture or video recording for social/advertising purposes to include but not limited to the parish website, parish social media and bulletin boards on church grounds.Registration FeeThe registration fee is waived if you register your child and you volunteer at VBS.VBS 2023 – 1 Child Participant Price: VBS 2023 – 2 Child Participants Price: VBS 2023 – 3 Child Participants Price: Total Credit CardCard Details Cardholder Name Δ
