Child 1 Name *

First Name

Last Name

Child 2 Name

First Name

Last Name

Child 3 Name

First Name

Last Name

Child 4 Name

First Name

Last Name

Parent or Guardian Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Photo Use Policy

By checking the box below understand and agree that my child(ren)'s image may be used on St. Paul's website or other promotional material. St. Paul's does not use or share any personal information of any kind.

I understand and agree to the image use policy

Medical Care Authorization

By checking the box below I authorize the staff and volunteers of VBS to administer basic medical care to my child(ren), and that in the event of an emergency I will be contacted at the phone number provided.

I understand and agree to the medical care authorization statement.