St. Cecilia Catholic Church · Registration Form for Rocky Railroad VBS 2020!

Contact Information

Mother's Full Name

Phone

Mom's Work or Cell #

Email

Verify Email

Father's Full Name

Phone

Dad's Work or Cell #

Email

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Children Information

Number of Children Registering: *

$35 - 1 Child

$70 - 2 Children

$105 - 3 Children

$140 - 4 Children

Name *

First Name

Last Name

T-Shirt Size *

Please select a t-shit size from the drop down:

Age *

Please select child's age from drop down menu:

Please select birthday month and year: *

*

Grade (Fall 2020) *

Allergies/Special Needs

Name *

First Name

Last Name

T-Shirt Size *

Please select a t-shirt size from the drop down:

Age *

Please select child's age from drop down menu:

Please select birthday month and year:

Grade (Fall 2020) *

Allergies/Special Needs

Name *

First Name

Last Name

T-Shirt Size *

Please select a t-shirt size from the drop down:

Age *

Please select child's age from drop down menu:

Please select birthday month and year: *

*

Grade (Fall 2020) *

Allergies/Special Needs

Name *

First Name

Last Name

T-Shirt Size *

Please select a t-shirt size from the drop down:

Age *

Please select child's age from drop down menu:

Please select birthday month and year: *

Grade (Fall 2020) *

Allergies/Special Needs

Emergency Contacts:

Emergency Contact (1) *

Phone *

Emergency Contact (2)

Phone

Who will be picking up your child/children? *

Phone *

Relationship *

2020 Parent/Guardian & Medical Consent Form

This form is to be completed by the parent or legal guardian of children under 18 years of age.

Medical Consent

By submitting this form below, I agree that in the event of an emergency, I give permission to the staff of St. Cecilia Catholic Church to seek emergency medical transport or treatment for my child/ren named below. I will be responsible for all cost incurred. I wish to be advised before the hospital or doctor gives further care. In the event of any accident or injury, i agree on behalf of myself, my child/ren’s other parent if known or living (name of parent below) the child/ren named below, or our heirs, successors, and assigns, to hold harmless and defend the Archdiocese of Galveston-Houston, its pastor or any representative of Faith Formation and Youth Ministry, unless the parties involved were careless and negligent.

Full Name of Parent/Guardian *

Phone *

Family Doctor

Phone

Insurance Phone Number

Check here if not insured

Full Name of Child

Date

(mm/dd/yyyy)

Video/Photograph Consent

As parent/guardian, I understand that promotional pictures and videos (individual and group may be taken during Faith Formation classes or youth Ministry activities. I give permission for my child's picture (named below) to be used for church promotional materials such as newsletters, web pages, calendar, Power Point presentations, or videos to promote or highlight these classes or activities. My child’s name will not be released without further consent.

Full Name of Parent/Guardian

Date

(mm/dd/yyyy)