VBS Child Registration

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- Faith Formation

VBS 2023 Student Registration

Registration Closes June 4th!

When:
June 12-16, 2023

Grades
Entering Grades K-6 for the 2023/2024 school year

Cost
1 camper: $25
2 campers: $50
3 or more campers: $75

NOTE
Scholarships available upon request.
The maximum number of form submissions has been reached. This form is currently not available.
- Contact Information
  
  Registered Family Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Name: Please enter valid data.
  
  Mother's name: Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Primary Phone Number: Maximum 20 characters Please enter a phone number.
- Emergency Contact Email: REQUIRED Please fill out this field. Please enter an email address.
- Emergency Phone Number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Interested in Volunteering (requires clearance) Yes No I need more information!
- Number of Students REQUIRED Please fill out this field.
  
  Student Information 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade 2023/2024 School Year: REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size: REQUIRED Please fill out this field.
  
  Special Needs/Allergies: Please enter valid data.
  
  Authorized Pickup: Please enter valid data.
  
  Authorized Pickup Phone Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Student Information 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade 2023/2024 School Year: REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size: REQUIRED Please fill out this field.
  
  Special Needs/Allergies: Please enter valid data.
  
  Authorized Pickup: Please enter valid data.
  
  Authorized Pickup Phone Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Student Information 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade 2023/2024 School Year: REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size: REQUIRED Please fill out this field.
  
  Special Needs/Allergies: Please enter valid data.
  
  Authorized Pickup: Please enter valid data.
  
  Authorized Pickup Phone Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Student Information 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade 2023/2024 School Year: REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size: REQUIRED Please fill out this field.
  
  Special Needs/Allergies: Please enter valid data.
  
  Authorized Pickup: Please enter valid data.
  
  Authorized Pickup Phone Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Student Information 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade 2023/2024 School Year: REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size: REQUIRED Please fill out this field.
  
  Special Needs/Allergies: Please enter valid data.
  
  Authorized Pickup: Please enter valid data.
  
  Authorized Pickup Phone Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Student Information 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade 2023/2024 School Year: REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size: REQUIRED Please fill out this field.
  
  Special Needs/Allergies: Please enter valid data.
  
  Authorized Pickup: Please enter valid data.
  
  Authorized Pickup Phone Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Student Information 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade 2023/2024 School Year: REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size: REQUIRED Please fill out this field.
  
  Special Needs/Allergies: Please enter valid data.
  
  Authorized Pickup: Please enter valid data.
  
  Authorized Pickup Phone Number: REQUIRED Please fill out this field. Please enter valid data.
  
  Student Information 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth: REQUIRED Please fill out this field. Please enter valid data.
  
  Gender: REQUIRED Please fill out this field. Please enter valid data.
  
  Grade 2023/2024 School Year: REQUIRED Please fill out this field. Please enter valid data.
  
  T-Shirt Size: REQUIRED Please fill out this field.
  
  Special Needs/Allergies: Please enter valid data.
  
  Authorized Pickup: Please enter valid data.
  
  Authorized Pickup Phone Number: REQUIRED Please fill out this field. Please enter valid data.
- Medical Matters
  Diocese of St. Augustine
  Catholic Center
  11625 Old St. Augustine Rd.
  Jacksonville, Fl 32258
  
  To my knowledge, my child is in good health, and I assume all responsibility for the health of my child.
  
  EMERGENCY MEDICAL TREATMENT
  In the event of an emergency, I hereby give permission to Diocese of St. Augustine's employees, volunteers, or representatives to seek medical treatment for my child above named.
  
  In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the Diocesan representatives or volunteers to hospitalize secure proper treatment for, and order injection and/or anesthesia and/or surgery for my child above named.
- Medical Matters REQUIRED I Agree I Disagree Please fill out this field.
- Media Release
  Diocese of St. Augustine
  Catholic Center
  11625 Old St. Augustine Rd.
  Jacksonville, Florida 32258
  Without compensation, I hereby grant permission to the Catholic Diocese of Saint Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved. The Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of St. Augustin and all of their employees and agents, from all claims and liability relating to said photographs.
- Media Release REQUIRED I Agree I Disagree Please fill out this field.
- Signature
- Additional Information/Comments
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
Submit

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