| Portland Peninsula & Island Parishes

Parent/Legal Guardian #1

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Relationship REQUIRED Please fill out this field.

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.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Phone Number (Secondary) Please enter a phone number.

Parent/Legal Guardian #2 (If applicable)

First Name Please enter valid data.

Last Name Please enter valid data.

Relationship

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Email Please enter an email address.

Phone Number Please enter a phone number.

Phone Number (Secondary) Please enter a phone number.

Emergency Contact

Please provide information for a local contact person in case a parent/legal guardian is unable to be reached in the event of an emergency

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Relationship to child(ren) REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Phone Number (Secondary) Please enter a phone number.

Children REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Nickname Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Age (At beginning of Vacation Bible School) REQUIRED Please fill out this field. Please enter valid data.
- Grade entering in Fall 2019 REQUIRED Please fill out this field. Please enter valid data.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Nickname Please enter valid data.
- Nickname Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
- Age (At beginning of Vacation Bible School) REQUIRED Please fill out this field. Please enter valid data.
- Age (At beginning of school year) REQUIRED Please fill out this field. Please enter valid data.
- Grade entering in Fall 2019 REQUIRED Please fill out this field. Please enter valid data.
- Grade in School REQUIRED Please fill out this field. Please enter valid data.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Nickname Please enter valid data.
- Nickname Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
- Age (At beginning of Vacation Bible School) REQUIRED Please fill out this field. Please enter valid data.
- Age (At beginning of school year) REQUIRED Please fill out this field. Please enter valid data.
- Grade entering in Fall 2019 REQUIRED Please fill out this field. Please enter valid data.
- Grade in School REQUIRED Please fill out this field. Please enter valid data.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Nickname Please enter valid data.
- Nickname Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
- Age (At beginning of Vacation Bible School) REQUIRED Please fill out this field. Please enter valid data.
- Age (At beginning of school year) REQUIRED Please fill out this field. Please enter valid data.
- Grade entering in Fall 2019 REQUIRED Please fill out this field. Please enter valid data.
- Grade in School REQUIRED Please fill out this field. Please enter valid data.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Nickname Please enter valid data.
- Nickname Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
- Age (At beginning of Vacation Bible School) REQUIRED Please fill out this field. Please enter valid data.
- Age (At beginning of school year) REQUIRED Please fill out this field. Please enter valid data.
- Grade entering in Fall 2019 REQUIRED Please fill out this field. Please enter valid data.
- Grade in School REQUIRED Please fill out this field. Please enter valid data.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Baptism REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Eucharist (Communion) REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- My child has received the Sacrament of Confirmation REQUIRED Please fill out this field.
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)
- Any known allergies? (Please note below) REQUIRED Please fill out this field.
- Allergies or other special needs? (Please list any allergies or special needs your child may have. This information will be kept confidential and only shared with those who need to know.)

Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Photo Release: I hereby grant the above named parish permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

Permission to Attend: I give permission for my child (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church, and that all registration information will be removed from the hosting site by December 31 of this year.

I Agree (Check this box and type name and date below for digital signature) Please select this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Relationship REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.