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

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

Your Email Address Please enter valid data.

Your Cell Phone # Please enter valid data.

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

City, State & Zip REQUIRED Please fill out this field. Please enter valid data.

Your T-shirt Size REQUIRED Please fill out this field.

Youth Helper Grade Entering Next Year Please enter valid data.

Emergency Contact

Emergency Contact Name Please enter valid data.

Emergency Contact Phone Number Please enter valid data.

Relationship Please enter valid data.

* * * * * * * HEALTH INFORMATION * * * * * * * Do you have any diagnosed medical conditions or learning disabilities or allergies? Please be specific.

Your Availability - Please check all that apply. REQUIRED ALL WEEK - Monday through Friday Monday Tuesday Wednesday Thursday Friday Please fill out this field.

As a Crew Leader/Helper please select which grade level you would prefer to work with. (We will do our best to honor your requests, but we cannot guarantee your choice). Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Media Release—

By marking the Media Release option on this VBS registration, I/we authorize that photographic images, video images or audio recordings can be taken of my child/ren, listed above on this registration form, as a participant in Vacation Bible School (hereafter VBS). These photographic images, video images and/or audio recordings for use within the parish and VBS in regards to publicizing or promoting VBS within the parish community. St Joseph parish is not authorized to sell or otherwise distribute these images or recordings to any other person or entity without my/our consent. I/we understand that St Joseph parish may associate the images or recordings with the first name only of the individual and the name of St Joseph parish or school. I/we acknowledge and agree that neither I nor the individual, if a minor, has or shall have any ownership interest in any information or advertising material which utilizes, incorporates or consists of the images or recordings or in any copyright embodied therein.

Parish affiliation: St Joseph Catholic Church 555 St Joseph Lane, Manchester, MO 63021

Media Release

Have you completed a "Protecting God's Children" session or a Minor Code of Ethics (if under 18)? REQUIRED Please fill out this field.

Saint Joseph Parish

567 St. Joseph Lane, Manchester MO 63021

VOLUNTEER REGISTRATION (Adult & Youth)

Media Release—