Vbs Registration Form
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1
2VBS Registration
Cost is $60.00 per child payable by cash or cheque
Paid by Cash: _________
to OLPH Parish by
Cheque #: ____________
June 5th with this form at time of registration to
receive a free t-shirt. No free T-shirt after June 6
th
Received by: __________
rd
Last day to register for camp is June 23
Date: ________________
PLEASE PRINT Clearly
1st Child’s Name _____________________________________ Birth date __________________
Age ________ Grade ______ (
) Alberta’s Health Care # ___________________
completed June 2017
T-shirt size ______ (
)
see below
2
nd
Child’s Name _____________________________________ Birth date __________________
Age ________ Grade ______ (
) Alberta’s Health Care # ___________________
completed June 2017
T-shirt size ______ (
)
see below
rd
3
Child’s Name _____________________________________ Birth date __________________
Age ________ Grade ______ (
) Alberta’s Health Care # ___________________
completed June 2017
T-shirt size ______ (
)
see below
Child(ren) lives with both parents: ☐ mother ☐ father ☐ other ☐ Specify: __________________
Family Doctor________________________________________ Phone # ___________________
Mother’s Name ___________________ Phone # __________________ Cell #_______________
Father’s Name ___________________ Phone # ___________________ Cell #_______________
Address _________________________________________________ Postal Code ___________
Email ________________________________ Alt. Phone # ______________________________
Emergency Contact Name _________________________ (Other than parent)
Phone Number _____________
th
Shirt included if registered by June 6
Please check the size with samples to confirm the correct size.
We will not have extra sizes to exchange.
Children sizes:
sm (6-8)
md (10/12) lg (14/16)
Adult Sizes: sm, md, large, xlarge, xxlarge
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