VBS Camper Pre-Registration

- Events

Use this form to pre-register for VBS at Immaculate now! Registration is finalized upon receipt of payment ($20 for the first child; $30 for the entire family; ask to speak with Fr. Capoverdi if your family requires a scholarship).
The maximum number of form submissions has been reached. This form is currently not available.
- Name of Child 1: REQUIRED Please fill out this field.
- Age REQUIRED Please fill out this field.
- Name of Child 2:
- Age
- Name of Child 3:
- Age
- Name of Child 4:
- Age
- Name of Child 5:
- Age
- Name of Child 6:
- Age
- Name of Child 7:
- Age
- Information
  
  Street Address (Street, City, State, and Zip) REQUIRED Please fill out this field.
  
  Parent Name REQUIRED Please fill out this field. Please enter valid data.
  
  Primary Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Secondary Phone Please enter valid data.
  
  Primary Email REQUIRED Please fill out this field. Please enter an email address.
  
  Secondary eMail Please enter an email address.
  
  Home Parish REQUIRED Please fill out this field. Please enter valid data.
- Photo Release
  
  We will be taking photographs of various activities and events during VBS. These photos may be displayed on the church's website, Facebook page, and/or bulletin board. We will not publicize photos of your children without your consent. Please complete the form below, indiciating your preference.
  
  8/2/2021-8/6/2021 REQUIRED YES, Immaculate Conception Church has my permission to use photos of my child(ren) NO, Immaculate Conception Church DOES NOT have my permission to use photos of my child(ren) Please fill out this field.
- Emergency
  
  In the event that you are unable to contact me, please contact:
  
  Emergency Contact 1 Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact 1 Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact 2 Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact 2 Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Food Allergies (enter "None" if applicable) REQUIRED Please fill out this field.
  
  Medical Concerns (enter "None" if applicable) REQUIRED Please fill out this field.
  
  I give permission for my child(ren) to participate in Vacation Bible School at Immaculate Conception Church on July 29 - August 2, 2019. This consent is finalized with receipt of payment.
  I Agree Please select this field.
Submit

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