Vacation Bible School Registration

Vacation Bible School: “Rainforest Falls”

Ages 4-9 (PreK – 5th grade)

August 3 – 7 9:00am – 12:00pm

Our Lady of Hope Social Center

78 Litchfield Road

Harwinton

Please register all children within one form. Save $10 when registering children for Religious Education program as well.

Company

This field is for validation purposes and should be left unchanged.

Family's Last Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code

Email(Required)

Primary Phone

Mother's name(Required)

Mother's Mobile Phone(Required)

Father's name(Required)

Father's Mobile Phone(Required)

Is there anyone else permitted to pick up your child(ren)?(Required)

yes

People other than parents who are permitted to pick up your child:

Name(Required)

Relationship(Required)

Name(Required)

Relationship(Required)

Name(Required)

Relationship(Required)

Is your family registered as parishioners at Our Lady of Hope Parish?(Required)

yes

Please list the children participating in VBS. Indicate the grade the child will be entering in September.

First name (and last name only if different from above)

Age

Grade

First name (and last name only if different from above)

Age

Grade

First name (and last name only if different from above)

Age

Grade

Special needs/Allergies

Please provide information regarding any child(ren) with special needs and/or allergies.

Parent/Guardian Signature(Required)

Please type your name as signature.

Date(Required)