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2023 VBC Registration Form

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    2023 VBC Registration Form
    
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We are so excited to have you at Vacation Bible Camp this summer!

Who: 4 years old through rising 6th graders
Where: Holy Infant Catholic Church, Desales Center
When: July 9-12, 5:30 p.m. - 7:30 p.m.

Cost: $35 for one child, $60 for two children, $75 dollars for three or more children. Financial assistance is available! Please contact Michalene Sutton (msutton@holyinfantchurch.org) for more information.
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- Family Last Name REQUIRED Please fill out this field. Please enter valid data.
- 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.
- Parent or Guardian First Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Parent or Guardian #2 First Name Please enter valid data.
- Email Please enter an email address.
- Phone Number Maximum 20 characters Please enter a phone number.
- Would you be willing to be an adult leader for all or part of Vacation Bible Camp? REQUIRED Yes No Please fill out this field.
- Child Information 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 or Rising Grade Level REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Allergies, Dietary Needs or Special Considerations
  
  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 or Rising Grade Level REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Allergies, Dietary Needs or Special Considerations
  
  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 or Rising Grade Level REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Allergies, Dietary Needs or Special Considerations
  
  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 or Rising Grade Level REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Allergies, Dietary Needs or Special Considerations
  
  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 or Rising Grade Level REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Allergies, Dietary Needs or Special Considerations
  
  Child 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.
  
  Age or Rising Grade Level REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Allergies, Dietary Needs or Special Considerations
- Photo and Video Release REQUIRED
  Photographs and videos are often taken during VBC. I acknowledge that these may be used in publications, websites or other materials produced from time to time by Holy Infant, the Faith Development Office or the Diocese of Raleigh. Participants would not be identified without specific written consent. Parents/Guardians who do not wish their child to be photographed or filmed should select "NO" and contact FD Office.
  Yes No Please fill out this field.
- I give permission for my child, in the event of an emergency, to be taken to a physician or hospital by either an adult leader or parish personnel. I understand that every effort will be made to contact me. If I cannot be reached, however, I hereby give permission to the physician selected by the adult in charge to hospitalize or secure proper treatment for my son or daughter.
- I Agree Please select this field.
- Registration Information REQUIRED 1 Child- $35 2 Children - $60 3 or more Children - $75 JYM/TYM Crew Leader - $15 Please fill out this field.
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