VBS Registration Form - Mary Queen of Peace Catholic Church

MQP Catholic Vacation Bible School
Monday July 20th – Thursday July 23rd 2015
Time: 9:00am – 12:00pm Location: St. Martin Hall
Children ages 4 to incoming 4th grade
Registration Form
Please Print (we need a registration for each participant)
Child’s Name:
Street Address:
Zip Code:
Home Phone:
Cell /Work Phone:
E-mail Address:
Incoming Grade Fall 2015:
Emergency Contact:
Emergency Phone #:
Allergies or other medical conditions we should know about:
T-Shirt Size (circle): Youth Sizes
Size XS
Size S
Size M
Size L
Adult Sizes
Size S Adult
Size M Adult
Cost: $32/per child ($64 family Max.) $10 Late fee if registration received after June 8th
Includes all activities for the week of VBS, T-Shirt, Music CD, & VBS Back Pack
Total Check Amount (made out to Mary Queen of Peace): $
Deadline to Register is June 8 $10 Late fee if received after this date and no
guarantee you will get a T-shirt or backpack in your size/color
Mail or turn in registration form with a check to the Parish Office: Mary Queen of Peace 21304
Church Ave. Rogers, MN 55374 Attn: Youth and Family. Phone #763-428-2585
Please sign Code of Conduct on back of registration
Code of Conduct:
Treat all other persons with respect and not cause any intentional harm (physically,
emotionally, or spiritually) to any person in any way.
Respect the property of others, including all program facilities and property.
Follow all appropriate instructions of all personnel aiding in this event.
To participate in the above event. I warrant that my child is in good health. In consideration of
my child’s participation, I agree to indemnify the parish/school from any claims or law suits
brought by myself, my child, or others, that arises out of any behavior by my child at the
event/activity described above. I acknowledge that my child may be in photos that will be used
for Mary Queen of Peace displays &/or bulletin announcements.
Parent/Guardian Signature