1408 North Davis Drive | Arlington, TX 76012
phone: 817-460-2278 | e-mail: stmaryarl@sbcglobal.net

VBS 2023

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  FAMILY INFO
  Parent/Guardian Contact 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.
  
  Name of Registered Parish Please enter valid data.
  
  CAMPERS (Children ages 3-11) REQUIRED
  Enter each child ATTENDING VBS
  Please fill out this field.
  
  CAMPER (Child aged 3-11) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  CAMPER (Child aged 3-11) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  CAMPER (Child aged 3-11) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  CAMPER (Child aged 3-11) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  CAMPER (Child aged 3-11) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  CAMPER (Child aged 3-11) 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  TEEN LEADERS (Volunteers aged 12-17) REQUIRED Please fill out this field.
  
  TEEN LEADER (Volunteer aged 12-17) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Email (best email to contact directly) REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number (best number to text during VBS) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  TEEN LEADER (Volunteer aged 12-17) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Email (best email to contact directly) REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number (best number to text during VBS) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  TEEN LEADER (Volunteer aged 12-17) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Email (best email to contact directly) REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number (best number to text during VBS) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  TEEN LEADER (Volunteer aged 12-17) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Email (best email to contact directly) REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number (best number to text during VBS) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  TEEN LEADER (Volunteer aged 12-17) 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.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Email (best email to contact directly) REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number (best number to text during VBS) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  TEEN LEADER (Volunteer aged 12-17) 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter an integer (number).
  
  Email (best email to contact directly) REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number (best number to text during VBS) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  ADULT VOLUNTEERS (Everyone 18+) REQUIRED
  Adult volunteers are one of our greatest needs! CHILDCARE AVAILABLE if needed!
  Please fill out this field.
  
  Adult Volunteer 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.
  
  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.
  
  Adult Volunteer 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.
  
  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.
  
  Adult Volunteer 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.
  
  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.
  
  Adult Volunteer 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.
  
  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.
  
  Adult Volunteer 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.
  
  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.
  
  Adult Volunteer 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name 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.
  
  By clicking "I agree" below, I am submitting my electronic signature to register my child(ren) for Vacation Bible School (VBS) at Saint Mary the Virgin on June 19-23, 2023. I hereby release and agree to indemnify and hold harmless the parish, its staff and their employees and agents, volunteers, and the Ordinariate of the Chair of Saint Peter from any and all liability, for injuries, damages, medical expenses or any other loss to my child or family, including attorney fees, arising from claims of any nature whatsoever from my child’s participation in this program.
  
  I grant permission for the administration of First Aid to my child(ren) listed above by the people in charge of VBS at St. Mary the Virgin, Arlington TX, to sign the necessary releases as may be required, and to make the necessary referrals to qualified physicians for the treatment of illness or accidents of a more serious nature for the duration of the 2022-2023 school year. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In the case of a medical emergency, I understand that every effort will be made to contact the parent/guardian of the participant. In the event that I cannot be reached, I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery if deemed necessary for my child for the duration of the VBS program.
  
  Video, still photographs, and audio recordings may be taken during VBS at St. Mary the Virgin, Arlington TX. Submission of this form constitutes permission for my child(ren)’s participation in videotaping, still photographs, and/or audio recordings, which may be used for future promotional efforts, including publications and websites for the Catholic Church of Saint Mary the Virgin and the Ordinariate of the Chair of Saint Peter.
  
  Authorization REQUIRED Please fill out this field.
  
  I will pay the registration fees ($25 per child, $75 family cap) via: REQUIRED Paypal (payable to: stmaryarl@sbcglobal.net) Check or cash (to the DRE or the Parish Office) Volunteer Only—No Fee Please fill out this field.
  
  Electronic Signature REQUIRED
  (Type your name)
  Please fill out this field. Please enter valid data.
  
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The Catholic Church of
St. Mary the Virgin

Parish of the Personal Ordinariate of the Chair of St. Peter

VBS 2023