VBS Registration – Mother Seton Catholic Church

Parent/Guardians Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone Contact*

Phone Contact #2*

Emergency Contact Name*

First Last

Emergency Contact Relationship*

Emergency Contact Phone*

Camper's Name*

First Last

Grade Entering in the Fall*

Date of Birth*

Gender*

Shirt Size*

Second Camper's Name

First Last

Grade Entering in the Fall

Date of Birth

Male or Female?

Shirt Size

Third Camper's Name

First Last

Grade Entering in the Fall

Date of Birth

Male or Female

Shirt Size

Fourth Camper's Name

First Last

Grade Entering in the Fall

Date of Birth

Male or Female

Shirt Size

Please List Any allergies.

Please List Any Medical Concerns

Registration Fee*

Price: $75.00 Quantity:

Total

$0.00