Vacation Bible Schools

 

Please checkmark the VBS you wish to be in. Every week follows a different theme. You are welcome to participate in more than one VBS.  

 

check VBS	Location	Dates	Registration deadline
	Williamstown & Area	July 5th to July 9th	June 30th
	East End of Cornwall	July 12th to July 16th	July 7th
	Finch & Area	August 2nd to August 6th	July 28th
	West End of Cornwall	August 9th to August 13th	August 4th
	Cornwall – français	19 juillet - 23 juillet	le 7 juillet
	Alexandria	August 23rd to August 27th	August 18th
	Crysler- français	16 août - 20 août	le 11 août

 

*Return completed form to Emilie Callan -

                                             E-mail: ecallan@alexandria-cornwall.ca

                                             Phone: 613-933-1138, ext.31 - Fax: 613-937-4931

                                             Mail:   220 Montreal Road, Cornwalll, ON  K6H 1B4

Name of Child:  ______________________________________________________________________________

 

Sex: (circle one)  M     F             Age:  _________________           Grade completed:  ___________________

 

Allergies or medical conditions:  ________________________________________________________________

 

Health Insurance # (if applicable):  ______________________________________________________________

 

Parents/Guardians’ Name(s): __________________________________________________________________

 

Mailing Address:  

Street _____________________________________           City____________________________

 

Postal Code___________________        E-mail Address: _______________________________

 

Phone Numbers:

 

Home _______________________   Week________________________

 

Cell___________________________

 

Emergency Contact:

 

Emergency Name:  ___________________________________________________________________________

 

Phone: __________________________________

LIABILITY RELEASE: I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge this Diocese, and Parish from all manners of actions, claims which I or the child named above shall or may have for any reason, arising during my child’s attendance of the VBS.

Unless other written instruction is submitted, I also consent to allowing my child’s image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of Parish VBS programs. Any other use will require your further consent.

 

 

____________________________________________________________         __________________________________________

                                   Parent / Guardian Signature                                                                                    Date

Registration fee is $15 per child or $35 per a family