Vacation Bible School Registration

Parent / Guardian Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Home Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED

Please provide a phone number that you will have access to during the time we have VBS.

Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact Information

Name of Emergency Contact REQUIRED

another parent, grandparent, nanny, etc.

Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Children for Registration

How many Children do you have to register? REQUIRED Please fill out this field.
Child 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.
- Age (as of June 13, 2022) REQUIRED Please fill out this field.
- T-Shirt Size REQUIRED Please fill out this field.
- Permission REQUIRED I/we, the parents or guardians of the above mentioned child, for myself/ourselves and for my/our child, give permission for my/our child to participate in the above mentioned event. Please fill out this field.
- Medical Authorization REQUIRED In the event of any injury or illness to my/our child during his/her participation in this event, I/we will apply my/our hospitalization and/or accident insurance toward the payment of the expenses incurred. Please fill out this field.
- Medical Matters REQUIRED I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Please fill out this field.
- Photo Release REQUIRED
  Permission is hereby granted to St. Catherine Labouré Parish of the Diocese of Pittsburgh to use voice recordings, photographs, and video of the above mentioned child to assist in its community awareness, and related public relations purposes.
  Yes No Please fill out this field.
- Any known allergies? (please include food and environmental) REQUIRED Please fill out this field. Please enter valid data.
- Is there any medication your child will need to take while at VBS? (please list medication and dosage) REQUIRED Please fill out this field. Please enter valid data.
- Any other information that you think would be helpful for us to know about your child? Please enter valid data.
Child 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.
- Age (as of June 13, 2022) REQUIRED Please fill out this field.
- T-Shirt Size REQUIRED Please fill out this field.
- Permission REQUIRED I/we, the parents or guardians of the above mentioned child, for myself/ourselves and for my/our child, give permission for my/our child to participate in the above mentioned event. Please fill out this field.
- Medical Authorization REQUIRED In the event of any injury or illness to my/our child during his/her participation in this event, I/we will apply my/our hospitalization and/or accident insurance toward the payment of the expenses incurred. Please fill out this field.
- Medical Matters REQUIRED I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Please fill out this field.
- Photo Release REQUIRED
  Permission is hereby granted to St. Catherine Labouré Parish of the Diocese of Pittsburgh to use voice recordings, photographs, and video of the above mentioned child to assist in its community awareness, and related public relations purposes.
  Yes No Please fill out this field.
- Any known allergies? (please include food and environmental) REQUIRED Please fill out this field. Please enter valid data.
- Is there any medication your child will need to take while at VBS? (please list medication and dosage) REQUIRED Please fill out this field. Please enter valid data.
- Any other information that you think would be helpful for us to know about your child? Please enter valid data.
Child 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.
- Age (as of June 13, 2022) REQUIRED Please fill out this field.
- T-Shirt Size REQUIRED Please fill out this field.
- Permission REQUIRED I/we, the parents or guardians of the above mentioned child, for myself/ourselves and for my/our child, give permission for my/our child to participate in the above mentioned event. Please fill out this field.
- Medical Authorization REQUIRED In the event of any injury or illness to my/our child during his/her participation in this event, I/we will apply my/our hospitalization and/or accident insurance toward the payment of the expenses incurred. Please fill out this field.
- Medical Matters REQUIRED I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Please fill out this field.
- Photo Release REQUIRED
  Permission is hereby granted to St. Catherine Labouré Parish of the Diocese of Pittsburgh to use voice recordings, photographs, and video of the above mentioned child to assist in its community awareness, and related public relations purposes.
  Yes No Please fill out this field.
- Any known allergies? (please include food and environmental) REQUIRED Please fill out this field. Please enter valid data.
- Is there any medication your child will need to take while at VBS? (please list medication and dosage) REQUIRED Please fill out this field. Please enter valid data.
- Any other information that you think would be helpful for us to know about your child? Please enter valid data.
Child 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.
- Age (as of June 13, 2022) REQUIRED Please fill out this field.
- T-Shirt Size REQUIRED Please fill out this field.
- Permission REQUIRED I/we, the parents or guardians of the above mentioned child, for myself/ourselves and for my/our child, give permission for my/our child to participate in the above mentioned event. Please fill out this field.
- Medical Authorization REQUIRED In the event of any injury or illness to my/our child during his/her participation in this event, I/we will apply my/our hospitalization and/or accident insurance toward the payment of the expenses incurred. Please fill out this field.
- Medical Matters REQUIRED I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Please fill out this field.
- Photo Release REQUIRED
  Permission is hereby granted to St. Catherine Labouré Parish of the Diocese of Pittsburgh to use voice recordings, photographs, and video of the above mentioned child to assist in its community awareness, and related public relations purposes.
  Yes No Please fill out this field.
- Any known allergies? (please include food and environmental) REQUIRED Please fill out this field. Please enter valid data.
- Is there any medication your child will need to take while at VBS? (please list medication and dosage) REQUIRED Please fill out this field. Please enter valid data.
- Any other information that you think would be helpful for us to know about your child? Please enter valid data.
Child 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.
- Age (as of June 13, 2022) REQUIRED Please fill out this field.
- T-Shirt Size REQUIRED Please fill out this field.
- Permission REQUIRED I/we, the parents or guardians of the above mentioned child, for myself/ourselves and for my/our child, give permission for my/our child to participate in the above mentioned event. Please fill out this field.
- Medical Authorization REQUIRED In the event of any injury or illness to my/our child during his/her participation in this event, I/we will apply my/our hospitalization and/or accident insurance toward the payment of the expenses incurred. Please fill out this field.
- Medical Matters REQUIRED I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. Please fill out this field.
- Photo Release REQUIRED
  Permission is hereby granted to St. Catherine Labouré Parish of the Diocese of Pittsburgh to use voice recordings, photographs, and video of the above mentioned child to assist in its community awareness, and related public relations purposes.
  Yes No Please fill out this field.
- Any known allergies? (please include food and environmental) REQUIRED Please fill out this field. Please enter valid data.
- Is there any medication your child will need to take while at VBS? (please list medication and dosage) REQUIRED Please fill out this field. Please enter valid data.
- Any other information that you think would be helpful for us to know about your child? Please enter valid data.

Registration Fee

The multiple child discount is for siblings only. Thank you for your understanding.

VBS Registration Fee REQUIRED Please fill out this field.

Would you like to support a child's VBS experience with a donation of your choosing? $ Please enter a positive decimal.

A Note Before Paying:

If you get a message that your session timed out, please do not fill out a new form and submit another payment. There seems to be some time delay in some institutions processing payments. The payment message sends out automatically to you if it doesn't get an "approved" indicator from the institution immediately. Please allow some time to pass before "re-paying".