Student Registration Form printable pdf download

Student Registration Form

St. Columbkill’s 2016 Vacation Bible School

June 20-24

9am-12pm

Closing Ceremony for friends & family to be held on Friday, June 24 at 12:00 pm

STUDENT REGISTRATION FORM

Enrollment Ages: Pre-K* through 5

grade for 2016-17 school year

*an adult volunteer is requested with the registration of all PreK students*

All completed VBS forms must be returned no later than June 1

Please return completed forms with registration fee to St. Columbkill Church,

200 Indian Spring Road, Boyertown PA 19512. All checks made payable to St. Columbkill Church

Non-refundable Registration Fee: $15 per child (includes 1 Cave Quest Music CD per family)

Allergies or Special Needs

$15

Child’s Name (please print)

Grade

M/ F

AGE

Fee

Entering

2016-2017

Total Due:

______

Parent’s name _____________________________________ Phone_________________

E-Mail_______________________________________________

Address __________________________City ______________ Zip _____________

Person responsible for pickup (if other than parent): ________________________Phone ________________

Emergency Contact ____________________________________Phone_____________ 

*Children are grouped according to grade. If your child would like to be in a different group in order to be with a special friend (or

sibling) indicate the friend’s name and grade here:

________________________________________________________________

*Photo/Video Release

I hereby give permission to St. Columbkill Church to use photo and/or video of my child in the closing ceremony on Friday, July 17.

____________________________________________

Signature of parent or guardian

For more information or questions, please contact Megan Repko (610) 689-4749 or

For office use only: Payment received: Amount: ___________ Date: _______By: _________

Payment type: __ Cash

__Check number: ________

CD issued: ____

Student Registration Form