Vacation Bible School - July 14-18, 2025

- REGISTER TODAY - SPACE IS LIMITED
- At True North VBS children will have a great time singing songs,
  watching skits, making crafts and playing games, but most important,
  they’ll learn how their lives can be transformed by God’s great love for them.
  This form is for children in grades 1st through 5th grades in the upcoming school year. Currently the 6, 7, 8 Jr. Leader program is full. Please do not register them here. If you would like to place your child on a waiting list, please email rosie.roope@gmail.com
  If you have a teen in high school who would like to be a Sr. Leader, please contact: rosie.roope@gmail.com.
  
  VBS Dates: Monday, July 14th through Friday, July 18th.
  Time: 8:30 A.M. - 12:00noon (with option for extended care to 4pm at an extra fee of $20. per day). Parents are required to pack a lunch for extended care students.
  Camper fee: $85. first child / $75 each additional sibling.
  Location: St. Francis Xavier Parish, 3801 Scott Road, Burbank, CA 91504 Contact: rosie.roope@gmail.com
- The maximum number of form submissions has been reached. This form is currently not available.
  
  FAMILY INFORMATION
  
  Family Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parish Please enter valid data.
  
  Parent 1: Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent 1: Cell Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Is there a second parent or guardian? REQUIRED Please fill out this field.
  
  Parent 2: Name Please enter valid data.
  
  Parent 2: Cell Phone Please enter valid data.
  
  Does child live with both parents? REQUIRED Please fill out this field.
  
  If no, please indicate Please enter valid data.
  
  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.
  
  Primary Email (used most often) REQUIRED Please fill out this field. Please enter valid data.
  
  Secondary Email: Please enter valid data.
  
  CHILD'S 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.
  
  Nickname Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Please fill out this field.
  
  School in the Fall REQUIRED Please fill out this field. Please enter valid data.
  
  Grade in the Fall REQUIRED Please fill out this field.
  
  Tee Shirt Size REQUIRED Please fill out this field.
  
  Are you enrolling your child in extended day care to 4pm? REQUIRED Please fill out this field.
  
  Primary Emergency Contact
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Secondary Emergency Contact
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  HEALTH INFORMATION
  
  Primary Doctor Contact: Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Health Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Policy # REQUIRED Please fill out this field. Please enter valid data.
  
  Group # REQUIRED Please fill out this field. Please enter valid data.
  
  Phone # Please enter valid data.
  
  List any allergies - medicines, foods, etc. REQUIRED Please fill out this field.
  
  Does your child have any medical or special needs, including medications currently being used? REQUIRED Please fill out this field.
  
  If yes, please explain:
  
  Operations or Serious Injuries, include the date:
  
  My child is up to date on immunizations: DPT, DPT Booster, Polio Series, Polio Booster REQUIRED Please fill out this field.
  
  If no, please explain
  
  Please notify the RE Office if this child is exposed to any communicable diesease during the three weeks prior to attendance.
  
  PERMISSION SLIP/MEDICAL RELEASE
  
  My child has my permission to attend Vacation Bible School at St. Francis Xavier Parish. In the event of illness or injury to my child during their attendance at an activity/meeting, I have provided the St. Francis Xavier Religious Education with the proper emergency contact information, health information describing my child’s medical problems (if any) in full as well as insurance information, and consent in advance to medical treatment. I understand that in the event of a serious illness or injury reasonable efforts to reach me will be attempted.
  
  AUTHORIZATION TO CONSENT TO TREATMENT OF MINOR: I give permission to the responsible staff members, volunteers, medical practitioners and medical facilities to use their judgement in obtaining and providing medical treatment for my son/daughter should it become necessary to do so. I agree to relieve the location and participating adults from liability in connection with this request. I understand that the insurance benefits through the Location, if any, may have limited application, and that I am entirely responsible for the cost of all medical treatment provided to my son/daughter. I agree to indemnify and hold the Location harmless from the cost of any medical treatment and related expense and cost incurred.
  
  RELEASE OF LIABILITY: As a condition of participating in the St. Francis Xavier Religious Education program I hereby hold harmless, release and discharge The Roman Catholic Archbishop of Los Angeles, a corporation sole, Archdiocese of Los Angeles Education & Welfare Corporation and the Location, their respective agents and employees and any parent/volunteer/chaperone, from any and all liability, loss or claims for personal injuries, wrongful death or property damage that I or my son/daughter my suffer as a result of participation in Religious Education activities.
  
  PHOTO ACKNOWLEDGEMENT:
  I understand that attendees at the event will be photographed for our slide show to be shown at the end of each day and may be used to share in our church bulletin or website.
  
  I Agree Please select this field.
  
  Parent/Legal Guardian (sign) and date REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship Please enter valid data.
  
  Cost to attend Vacation Bible Camp REQUIRED Please fill out this field.
  
  Cost to attend Extended Care to 4:00 PM daily
  
  Total:
  
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Vacation Bible School - July 14-18, 2025

REGISTER TODAY - SPACE IS LIMITED