St. Mary Mother of the Church 2008 Vacation Bible Camp

Date: June 23 - June 27 Time: 9:00 a.m. - 12:00 p.m.

STUDENT REGISTRATION FORM

(one child per form) (Eligibility: Ages 4 through 9)

Registration Dates and Fees:

April 28 - June 8, 2008 St. Mary Parishioners $30.00

Non-parishioners $35.00

**Please note: Due to preparation purposes, we will absolutely not be able to accept registrations after June 8, 2008. Thank you for your cooperation.

Name_______________________________________________ Date of Birth______________

Age child will be on June 1, 2008: ________ (must be at least 4 years of age)

Known allergies or other medical concerns: _____________________________________________

T-shirt size: Note: T-shirt deadline: June 8, 2008

Youth: Small (6-8)_______ Medium (10-12)_______ Large (14-16)______

Parent(s) _____________________________________________________________________

Phone (hm)________________ (wk)_________________ (cell)________________

Street Address______________________________________ City_______________ Zip_________

Emergency contact (if parent cannot be reached): Name___________________________________

Phone _______________________ Relationship to child ___________________________

_________________________________________________________________________________

Permission Slip

The undersigned hereby releases St. Mary Church Parish and all others in any way related thereto from any claims for all damage whatsoever resulting from your child’s participation in any St. Mary Vacation Bible Camp activities and agrees to indemnify and hold same harmless from all claims for damages to either person or property arising out of or relating from the activities.

Lafayette, Louisiana, this ______day of _____________2008. Signed:________________________

_________________________________________________________________________________

**CALL ME! I WANT TO HELP WITH THIS YEAR’S VBC! YES______ NO______

_________________________________________________________________________________

** For more information please contact Naomi Broussard, VBC Coordinator, at 288-2711.

Office use only: date paid______________ initials________ check # ________