Holy Maternity of Mary
Dowagiac, Michigan

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Vacation Bible School

- Ministries
registration form vbs
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- Participant Name REQUIRED Please fill out this field. Please enter valid data.
- Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
- Grade Entering in Fall 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.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
- Emergency Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Physician Name REQUIRED Please fill out this field. Please enter valid data.
- Physician Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Food Allergies/Medical Concerns/ Behavioral Concerns REQUIRED Please fill out this field.
- I consent for my child's picture to be taken and displayed at Sacred Heart of Mary for the VBS Program Yes No
- Drop-off/Pick-up Responsible Parties and Phone Numbers REQUIRED
  This list should include car pool groups and any other parents, relative or friends who are permitted to drop-off or pick-up your child(ren). NO CHILDRED WILL BE ALLOWED TO BE DROPPED OFF OR PICKED UP BY ANYONE OTHER THANK THE LISTED INDIVIDUALS UNDER ANY CIRCUMSTANCES. Every child will be signed in and out.
  Please fill out this field.
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