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 St. Mary's Vacation Bible School will be held from
JULY 14 - 18, 2008 9 AM - 12:30 PM
"FRIENDSHIP TREK"
SHIRT INCLUDED THIS YEAR

Vacation Bible School is open to Children who are entering
Kindergarten - 5th Grade in September 2008
-------------------------------------------------------------------------------------------------------------------------------------
Early Registration Fees:             St. Mary's Church                         Registration Fees (after 5/31)
 (Deadline - 5/31/08)                     East Islip, NY                                     (Deadline - 7/1/08)
1st Child - $45.00                     VBS REGISTRATION CARD         1st Child - $50.00
2nd Child - $40.00                     (One form per child, please)        2nd Child -$45.00
3rd Child - $35.00                                                                                3rd Child - $40.00
Price Includes T-Shirt (Please Circle Size- M L XL)

CHILD'S NAME:___________________________________   
Grade Enrolled 9/08__________DOB_________________
Parent's  Names:___________________________________________________
Address:__________________________________________________________
Phone #:__________________           Alternate Phone #:__________________

Emergency Contact: __________________________________________________________
 Phone#:______________________  Relationship to Child:__________________________
Alternate Phone #:____________________

ALLERGIES/MEDICAL  PROBLEMS:___________________________________________
CURRENT MEDS:________________________________________
Family Doctor and Phone:_________________________________

Church Membership at:________________________________________________________

NAMES OF ADULTS WHO MAY PICK UP YOUR CHILD IN YOUR ABSENCE:
_____________________________________________________________________________

PLEASE ASSIGN MY CHILD WITH THIS FRIEND:________________________________
(Assignments are up to the discretion of the coordinator)

 


 
    I request that my child _____________________________ participate in Saint Mary’s R.C. Church Vacation Bible School    
   and its activities from July 23 through July 27, 2007.

 As the natural guardian of the above-named child, I hereby appoint the adult VBS staff as my attorney-in-fact who is 
    authorized to consent to

any and all medical intervention, treatment, or care in which their sole discretion is deemed in the best interest of my child.  I agree to hold

harmless any person who provides medical care, treatment, or assistance in reliance on the authorization given in this document.  I

understand as a parent and natural guardian I will remain responsible for the cost of any such care.  I specifically intend that this instrument

be implemented and enforceable in the State of New York .

 

 



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