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VBS Registration

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Registration Information

For ages Pre-K (ages 4 and potty trained) through those entering 5th grade next school year. $40 per child/$60 for two or more children from the same family. Checks payable to Immaculaate Heart of Mary VBS. Contact Bernadette or Justine with questions at [email protected] or call or text 970-261-7183. Deadline for registration is June 3rd.
Authorization

By clicking on the "Submit" button below, I the parent/guardian of the child/children listed below, hereby release the Diocese of Pueblo, Immaculate Heart of Mary Catholic Church, it's staff, and the adult volunteers, of the reponsibility regarding possible injury, accident, sickness, etc., that might occur during the event. In understand that the organizers are taking all reasonable precautions to make this a safe and enjoyable experience. I also understand that if the child/children is/are ill, they will not be allowed to attend VBS that day. Immaculate Heart of Mary will make every effort to reimburse the pro-rated registration fee.
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- Parent Name (Last, First) REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Street 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.
- Health Insurance Company REQUIRED Please fill out this field. Please enter valid data.
- Policy Number REQUIRED Please fill out this field. Please enter valid data.
- Anyone else authorized to pick up your child/children Please enter valid data.
- I give my permission for my child/children to attend VBS at IHM. REQUIRED Yes No Please fill out this field.
- I give permission for my child/children to be photographed and for their images(s) to be used in any promotional materials created by the Parish. REQUIRED Yes No Please fill out this field.
- # of Children REQUIRED Please fill out this field.
  
  Child 1
  
  Name Please enter valid data.
  
  Entering Grade Please enter valid data.
  
  Allergies/Special Needs Please enter valid data.
  
  Child 2
  
  Name Please enter valid data.
  
  Entering Grade Please enter valid data.
  
  Allergies/Special Needs Please enter valid data.
  
  Child 3
  
  Name Please enter valid data.
  
  Entering Grade Please enter valid data.
  
  Allergies/Special Needs Please enter valid data.
  
  Child 4
  
  Name Please enter valid data.
  
  Entering Grade Please enter valid data.
  
  Allergies/Special Needs Please enter valid data.
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