St. Vincent de Paul Parish

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Vacation Bible Camp

- Formation

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- 2022 VBC REGISTRATION
  
  When: June 22-24, 2022
  Monday-Friday 9:30am-12:30pm
  
  Where: St. Vincent de Paul Formation Center Gym
  (doors open at 9:20am)
  
  Ages: Children entering Kindergarten* thru Grade 5
  (*must be 5 by 10/01/22)
- Parent/Guardian Information:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name 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.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Parishioner yes no
- First Emergency Contact (if parent cannot be reached)
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Camper REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Type REQUIRED Please fill out this field.
- Second Emergency Contact (if parent cannot be reached)
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Camper REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Type REQUIRED Please fill out this field.
- I authorize the following to pick my child(ren) up from VBC: Please enter valid data.
- I/we request that my/our son/daughter(s) attend the Vacation Bible Camp under the auspices of St. Vincent DePaul Church to be held on June 22 to 24, 2022. I/we have read the foregoing Health information/Release of Liability/Consent to Treat Form, and the answers are all correct. I/we can be reached at the telephone numbers referred to above, but if emergency medical care or treatment shall be necessary, and I/we cannot be contacted, I/we authorize the delegated agents of St. Vincent’s Staff to act on my/our behalf and approve appropriate treatment.
  Release of Liability: The undersigned intends to participate in the Vacation Bible Camp from June 22 through June 24. 2022, organized by St. Vincent DePaul Church. The undersigned hereby agrees to forfeit any and all claims against the Parish, the Bishop, the Diocese of Paterson, and its agents, servants, volunteers, and employees arising during or as a result of the aforementioned activity. The undersigned hereby releases the Bishop, the Parish, the Diocese of Paterson, and its agents, servants, volunteers and employees from any and all liability, loss, cost, expense or damage, including suits, claims, and demands of every kind and nature, including punitive damages, arising out of or based upon any accident, injury, or damage, however occurring, which may happen on or off the St. Vincent DePaul Church premises, which in any way relates to or arises from the undersigned’s participation in such off-Parish activity. The undersigned expressly releases St. Vincent DePaul Church, the Bishop, the Diocese of Paterson, and its agents, servants, volunteers, and employees from any and all liability, damage, or loss which may be occasioned by reason of any defect in any vehicle, or through the acts of default of any person or company engaged in conveying passengers, or in carrying out the arrangements of the event, including losses due to delays or changes in means of transportation.
- I Agree Please select this field.
- Number of Children Registering REQUIRED Please fill out this field.
  
  Child 1
  
  Full name REQUIRED Please fill out this field. Please enter valid data.
  
  Age (on 10/1/20) REQUIRED Maximum 2 characters Please fill out this field. Please enter valid data.
  
  Grade (Sept 2020) REQUIRED Maximum 1 characters Please fill out this field. Please enter valid data.
  
  Please explain any medical, allergy or other information you want us to be aware of: REQUIRED Please fill out this field.
  
  Child 2
  
  Full name REQUIRED Please fill out this field. Please enter valid data.
  
  Age (on 10/1/20) REQUIRED Maximum 2 characters Please fill out this field. Please enter valid data.
  
  Grade (Sept 2020) REQUIRED Maximum 1 characters Please fill out this field. Please enter valid data.
  
  Please explain any medical, allergy or other information you want us to be aware of: REQUIRED Please fill out this field.
  
  Child 3
  
  Full name REQUIRED Please fill out this field. Please enter valid data.
  
  Age (on 10/1/20) REQUIRED Maximum 2 characters Please fill out this field. Please enter valid data.
  
  Grade (Sept 2020) REQUIRED Maximum 1 characters Please fill out this field. Please enter valid data.
  
  Please explain any medical, allergy or other information you want us to be aware of: REQUIRED Please fill out this field.
  
  Child 4
  
  Full name REQUIRED Please fill out this field. Please enter valid data.
  
  Age (on 10/1/20) REQUIRED Maximum 2 characters Please fill out this field. Please enter valid data.
  
  Grade (Sept 2020) REQUIRED Maximum 1 characters Please fill out this field. Please enter valid data.
  
  Please explain any medical, allergy or other information you want us to be aware of: REQUIRED Please fill out this field.
  
  Child 5
  
  Full name REQUIRED Please fill out this field. Please enter valid data.
  
  Age (on 10/1/20) REQUIRED Maximum 2 characters Please fill out this field. Please enter valid data.
  
  Grade (Sept 2020) REQUIRED Maximum 1 characters Please fill out this field. Please enter valid data.
  
  Please explain any medical, allergy or other information you want us to be aware of: REQUIRED Please fill out this field.
  
  Child 6
  
  Full name REQUIRED Please fill out this field. Please enter valid data.
  
  Age (on 10/1/20) REQUIRED Maximum 2 characters Please fill out this field. Please enter valid data.
  
  Grade (Sept 2020) REQUIRED Maximum 1 characters Please fill out this field. Please enter valid data.
  
  Please explain any medical, allergy or other information you want us to be aware of: REQUIRED Please fill out this field.
- Payment REQUIRED Please fill out this field.
- Click proceed to payment to register.
  
  If paying online submit registration and proceed to payment screen
  
  If you are paying by check please submit payment to:
  
  St Vincent de Paul Church
  Attn: VBC
  250 Bebout Ave
  Stirling, NJ 07980
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Vacation Bible Camp

Parent/Guardian Information: