VBS Student Registration

NUMBER OF CHILDREN REQUIRED Please fill out this field.
Child's Information 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.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 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.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 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.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 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.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 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.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 9
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.
Child's Information 10
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in the Fall REQUIRED Please fill out this field.
- Gender REQUIRED Male Female Please fill out this field.

PARENT/GUARDIAN INFO

Parent/Guardian 1 REQUIRED Please fill out this field. Please enter valid data.
Parent/Guardian 2 Please enter valid data.
Can you volunteer to help? REQUIRED Yes No Please fill out this field.
If you can help, please fill out the Volunteer Form.
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.
Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Secondary Phone Number Maximum 20 characters Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.

PERSONS AUTHORIZED TO PICK UP/DROP OFF CHILD & RELATIONSHIP:

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.
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.

I will allow my child(ren)'s photo to be put on the parish website. REQUIRED Yes No Please fill out this field.

Parent Signature REQUIRED Please fill out this field. Please enter valid data.

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

MEDICAL RELEASE FORM

Name of Event: VBS 2026 - Rainforest Falls

Monday - Friday, July 20 - 24, 2026, 9:00am-1:00pm, Friday 30-minute parent program ends at 1:00pm at St. Joseph Catholic Church, 4521 N. Arden Rd. Otis Orchards, WA 99027

I (we) the undersigned parent(s) or guardian(s) of:

NUMBER OF MINORS REQUIRED Please fill out this field.
Minor 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.
Minor 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.
Minor 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.
Minor 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.
Minor 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.
Minor 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
Minor 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
Minor 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
Minor 9
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
Minor 10
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.

Do hereby authorize adult staff and volunteers of St. Joseph Catholic Church, St. Mary Catholic Church, St. John Vianney Catholic Church and St. Paschal Catholic Church as agent(s) for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability of St. Joseph Catholic Church, St. Mary Catholic Church, St. John Vianney Catholic Church and St. Paschal Catholic Church, any of its ministries or leaders in the event of an accident in route, during and returning from the above-mentioned event. This agreement does not apply to claims of intentional misconduct or gross negligence.

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

Parent/Legal Guardian Signature REQUIRED Please fill out this field. Please enter valid data.

Health Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Doctor Name (Optional) Please enter valid data.

If parent/legal guardian is not available in an emergency contact:

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

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

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

Please list any allergies and indicate severity: REQUIRED Please fill out this field.

If your child(ren) has a food allergy, will you be providing an alternate snack? REQUIRED Yes No My Child(ren) Do Not Have a Food Allergy Please fill out this field.

Does your child(ren) have any medical conditions or special needs, including medication currently being used? REQUIRED Please fill out this field.

YEAR OF LAST TETANUS SHOT REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 9
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.
Child 10
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Year REQUIRED Please fill out this field. Please enter valid data.

St. Joseph Catholic Parish

4521 Arden Road, Otis Orchards, WA 99027
Phone: 509-926-7133

Monday - Thursday | 8:30am - 4:30pm
Friday | 8:30am - 1:30pm

VBS Student Registration

Vacation Bible School 2026

VBS Student Registration Form

MEDICAL RELEASE FORM