Vacation Bible School Registration

Parent 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.

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.

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

Email REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

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

Number of children being registered REQUIRED Please fill out this field.
Child 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 a date.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering Fall 2025 (Next School Year) REQUIRED Pre-K 4 Kindergarten 1st 2nd 3rd 4th 5th Please fill out this field.
- T-Shirt size REQUIRED Please fill out this field.
- Allergies/other concerns
Child 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 a date.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering Fall 2025 (Next School Year) REQUIRED Pre-K 4 Kindergarten 1st 2nd 3rd 4th 5th Please fill out this field.
- T-Shirt size REQUIRED Please fill out this field.
- Allergies/other concerns
Child 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 a date.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering Fall 2025 (Next School Year) REQUIRED Pre-K 4 Kindergarten 1st 2nd 3rd 4th 5th Please fill out this field.
- T-Shirt size REQUIRED Please fill out this field.
- Allergies/other concerns
Child 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 a date.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering Fall 2025 (Next School Year) REQUIRED Pre-K 4 Kindergarten 1st 2nd 3rd 4th 5th Please fill out this field.
- T-Shirt size REQUIRED Please fill out this field.
- Allergies/other concerns
Child 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 a date.
- Age REQUIRED Please fill out this field. Please enter an integer (number).
- Grade Entering Fall 2025 (Next School Year) REQUIRED Pre-K 4 Kindergarten 1st 2nd 3rd 4th 5th Please fill out this field.
- T-Shirt size REQUIRED Please fill out this field.
- Allergies/other concerns

Registration fee (per camper) REQUIRED Please fill out this field.

I give permission for my child(ren) to be photographed or videotaped for our daily slide shows: REQUIRED Yes No Please fill out this field.

Saint Edward Church 450 Walnut Street Blawnox, PA 15238 412-828-4066	Saint Joseph Church Administrative Center 342 Dorseyville Road Pittsburgh, PA 15215 412-963-8885	Madonna of Jerusalem Church 201 9th Street Sharpsburg, PA 15215 412-784-8700	Saint Mary Church 210 Garnier Street Sharpsburg, PA 15215 412-784-8700	Saint Scholastica Church 309 Brilliant Avenue Aspinwall, PA 15215 412-781-0186
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