2025 Summer VBS Registration Form

# of children to register REQUIRED Please fill out this field.
Registration 1
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Grade completed REQUIRED Please fill out this field. Please enter valid data.
- Allergies or medical conditions REQUIRED Please fill out this field. Please enter valid data.
Registration 2
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Grade completed REQUIRED Please fill out this field. Please enter valid data.
- Allergies or medical conditions REQUIRED Please fill out this field. Please enter valid data.
Registration 3
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Grade completed REQUIRED Please fill out this field. Please enter valid data.
- Allergies or medical conditions REQUIRED Please fill out this field. Please enter valid data.
Registration 4
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Grade completed REQUIRED Please fill out this field. Please enter valid data.
- Allergies or medical conditions REQUIRED Please fill out this field. Please enter valid data.
Registration 5
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Grade completed REQUIRED Please fill out this field. Please enter valid data.
- Allergies or medical conditions REQUIRED Please fill out this field. Please enter valid data.
Registration 6
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Grade completed REQUIRED Please fill out this field. Please enter valid data.
- Allergies or medical conditions REQUIRED Please fill out this field. Please enter valid data.

Parents/Guardians' Names 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.

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

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

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

Emergency Contact REQUIRED Please fill out this field. Please enter valid data.

Emergency contact phone number REQUIRED Please fill out this field. Please enter a phone number.

I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or othe legal guardian(s) cannot be reached.

I Agree Please select this field.

I hereby do release and forever discharge the Diocese of Sioux City, and Sacred Heart Parish from all manners of actions, claims which I or the child/children named above shall or may have for any reason, arising during my child's attendance of the VBS.

I Agree Please select this field.

As parent/guardian, I understand that pictures and videos (individual and group) may be taken during the week of the summer VBS. I give permission for my child(ren)'s (named above) pictures to be shared on our Sacred Heart Parish website, Facebook page or other church related media.

I Agree Please select this field.

By signing and dating, you will give permission for your child(ren) to attend the Sacred Heart Parish Summer VBS program.

Parent Signature (first and last name) REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.