VBS Registration

June 3 - 7, 2024 from 9:00 AM - 11:30 AM

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

Date REQUIRED

Enter today's date

Please fill out this field. Please enter a date.

Email REQUIRED

This is used for communication for events and activities, as well as submission and payment confirmation.

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

Parent Information

Father's Name Please enter valid data.
Father's Phone # Maximum 20 characters Please enter a phone number.
Mother's Name Please enter valid data.
Mother's Phone # Maximum 20 characters Please enter a phone number.
Teachers & Aides
Please check any where you are able to assist
Teach Aide Other (indicate below)
Other assistance (please specify)
If you are able to assist in some other way, please share.
Please enter valid data.

Student Information

Number of Children REQUIRED Please fill out this field.
Child 1
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade (as of Fall 2023)
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 2
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade (as of Fall 2023)
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 3
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade (as of Fall 2023)
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 4
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade (as of Fall 2023)
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 5
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade (as of Fall 2023)
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.
Child 6
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- School Please enter valid data.
- Grade (as of Fall 2023)
- Please list any allergies or medical conditions of which the staff should be aware.
- Allergies / Other Awareness
- Release of liability
  
  I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
  
  I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
  I Agree and Confirm My Understanding Please select this field.

Tuition Cost REQUIRED

Please select the appropriate option for tuition

30.0 – One Child 60.0 – Two Children 75.0 – Family Rate Please fill out this field.

Resurrection Catholic Church

Grand Island, NE

Vacation Bible School (VBS) Registration Form