VACATION BIBLE SCHOOL 2017 Participant Registration Form — — — — — June 19-23 St. Mary School Kids Ages 9AM—12:15PM East Dubuque, IL 4 to 10 $35/per child C hild’snCformtFeblmoE C C m eSCirmccccccccccccccccccccccccccccccccccccccccccccccccccccccccccm m m liormnFAgGdimptiTmmmhmmmzm sXirmcccccccccm LgS’imFpCHdiWi’rmccccccccccm m m kElbAgWmlAfirmnFAgGdimptiTmGbAd’mRAfiRrmmVlmmlmmhmmBmmmS’dWmRAfiRrmmlmmhmmmBmmVBm m m sddigXAiRmpgmCi’AGSdmGpt’AWAptRrmccccccccccccccccccccccccccccccccccccccm m geFldcCformtFeblmoE C m m SgitWRLSg’AStRmeSCinRTrmccccccccccccccccccccccccccccccccccccccccm m m s’’giRRrmccccccccccccccccccccccccccccccccccccccccccccccccccccccccm m RimopCJFptnE C m m m pCirmcccccccccccccccccmpgrmcccccccccccccccmFiddrmcccccccccccccccccccm m m CSAdrmccccccccccccccccccccccccccccccccccccccccccccccccccccccccccm m FptpocChmobebE C m m eSCirmccccccccccccccccccccccccccccccccccmbptirmcccccccccccccccccccccm m I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I herby do release and forever discharge the Diocese, and Parish from all manners of actions, claims, which I or the child named above shall or may have for any reason, arising during my child’s attendance of the VBS. Unless other written instruction is submitted, I also consent to allowing my child’s image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of Parish VBS programs. Any other use will require your further consent. C Parent/Guardian Signature Date –––––––––––––––––––––––––––––––— m pbtoCmFdpbp’C rmtFCcCmo’ecCopCCC [torecicshcr]rtsetr m zpgCRmCSmim’gpHHi’m Atm WbimGpddiGWAptmSRiWmSWmGbgGbm’gpHHi’mpmSWmlWmhSgmm m iGWpgmpgmCSAdi’m WpmlmmhptWXpCigmsitimSRWmimBmm
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VACATION BIBLE SCHOOL 2017
Participant Registration Form —
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June 19-23 St. Mary School Kids Ages 9AM—12:15PM East Dubuque, IL 4 to 10 $35/per child
Child’snCformtFeblmoECCm eSCirmccccccccccccccccccccccccccccccccccccccccccccccccccccccccccmmm liormnFAgGdimptiTmmmhmmmzm sXirmcccccccccm LgS’imFpCHdiWi’rmccccccccccmmm kElbAgWmlAfirmnFAgGdimptiTm GbAd’mRAfiRrmmVlmmlmmhmmBmm"mS’#dWmRAfiRrmmlmmhmmmBmmVBmmm sddigXAiRmpgmCi’AGSdmGpt’AWAptRrmccccccccccccccccccccccccccccccccccccccmmgeFldcCformtFeblmoEC
mm $SgitWR"L#Sg’AStR%meSCinRTrmccccccccccccccccccccccccccccccccccccccccmmm s’’giRRrmccccccccccccccccccccccccccccccccccccccccccccccccccccccccmmRimopCJ�F�ptnEC
m mm &pCirmcccccccccccccccccm'pg(rmcccccccccccccccmFiddrmcccccccccccccccccccmmm )CSAdrmccccccccccccccccccccccccccccccccccccccccccccccccccccccccccmm�Fpt�po�cChmobe�bEC
mm eSCirmccccccccccccccccccccccccccccccccccm$bptirmcccccccccccccccccccccmmI understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I herby do release and forever discharge the Diocese, and Parish from all manners of actions, claims, which I or the child named above shall or may have for any reason, arising during my child’s attendance of the VBS. Unless other written instruction is submitted, I also consent to allowing my child’s image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of Parish VBS programs. Any other use will require your further consent.
CParent/Guardian Signature Date
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m zpgCRmCS*m+im’gpHHi’mAtmWbimGpddiGWAptm+SR(iWmSWmGb#gGb,m’gpHHi’mp--mSWmlW.mhSg*mmm /iGWpg*mpgmCSAdi’mWpm01l,m234mhptWXpCig*ms5it#i,m)SRWm6#+#7#i,m8Bm924:;m
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