EmailMe Form - Vacation Bible School 2024

Parent / Guardian Information

Primary Contact's Name *

First MI Last

Primary Contact's Phone # *

### - ### - ####

Primary Contact's Email *

Primary Contact's Role *

Child(ren)'s Primary Address *

Street Address City State / Province / Region Postal / Zip Code

Are you attending All Saint's PSR programs for Religious education only? *

Yes

No

Please provide the name of the parish where your child is registered and for how long.

Secondary Contact's Name *

First MI Last

Secondary Contact's Cell Phone *

### - ### - ####

Secondary Contact's Email *

Secondary Contact's Role *

Secondary Contact Same Address as Child(ren)'s Above? *

Yes

No

Secondary Contact's Home Address

Street Address City State / Province / Region Postal / Zip Code

Parent / Guardian Volunteer Opportunities

	How I would like to help?
Teacher
Teacher Assistant
Dismissal Helper
As a Photographer at select events
Craft Helper
Decorating
Game Helper
Teacher Appreciation
Kitchen Helper
Music Helper
Craft Head and Games Head

Everyone is asked to Provide Refreshments. Please click one

	How I would like to help?
Monday
Tuesday
Wednesday
Thursday
Friday

Non-Parent Emergency Contact

Relative or friend to contact if unable to reach parent/guardian in the event of emergency:

Name of Non-Parent Emergency Contact *

First Last

Relationship *

Phone number *

### - ### - ####

How many Children are you registering? *

Child # 1

Name of Child *

First Middle Last

Nickname

Grade Completed (2023 - 2024) *

Gender *

Male

Female

Birthday *

MM / DD / YYYY

Child's Current Age *

School Name *

Other - School Name

If your school name wasn't listed, please type here.

Please list any special considerations we need to be aware of (i.e: allergies, medical conditions, limitations, etc.) *

Medications: My Child is taking the following medication(s)

	Name	Dose
Medication #1
Medication #2
Medication #3

Anything we should know about your child that can help us journey with him/her in the faith.

Child # 2

Name of Child *

First Middle Last

Nickname

Grade (2022-2023) *

Gender *

Male

Female

Birthday *

MM / DD / YYYY

Child's Current age *

School Name *

Other - School Name

If your school name wasn't listed, please type here.

Please list any special considerations we need to be aware of (i.e: allergies, medical conditions, limitations, etc.) *

Medications: My Child is taking the following medication(s)

	Name	Dose
Medication #1
Medication #2
Medication #3

Anything we should know about your child that can help us journey with him/her in the faith.

Child # 3

Name of Child *

First Middle Last

Nickname

Grade Completed (2023 - 2024) *

Gender *

Male

Female

Birthday *

MM / DD / YYYY

Child's Current age *

School Name *

Other - School Name

If your school name wasn't listed, please type here.

Anything we should know about your child that can help us journey with him/her in the faith.

Medications: My Child is taking the following medication(s)

	Name	Dose
Medication #1
Medication #2
Medication #3

Please list any special considerations we need to be aware of (i.e: allergies, medical conditions, limitations, etc.) *

Child # 4

Nickname

Name of Child *

First Middle Last

Grade Completed (2023 - 2024) *

Gender *

Male

Female

Birthday *

MM / DD / YYYY

Child's Current age *

School Name *

Other - School Name

If your school name wasn't listed, please type here.

Please list any special considerations we need to be aware of (i.e: allergies, medical conditions, limitations, etc.)

Medications: My Child is taking the following medication(s)

	Name	Dose
Medication #1
Medication #2
Medication #3

Anything we should know about your child that can help us journey with him/her in the faith.

Payment Information:

Cash & Check Annual Fee:
$50 per Child

Payment is used for supplies, subscriptions, and rewards.

Payment Options: *

Cash

Check

I need a

Half Scholarship $25

Full Scholarship $50

NO CHILD IS EVER TURNED AWAY FOR LACK OF FUNDS!

I would like to sponsor an elementary school child:

Half Scholarship $25

Full Scholarship $50

Last Name of Payer (optional):

*Please fill out only if payer last name is different than child.

Payment Plan Information

* All Checks should be made out to All Saints Catholic Church.

* Please write on the memo line the name(s) of your child(ren).

* If you pay with cash feel free to bring the cash to PSR.

* Office Hours: M-F 9AM - 2PM

PARENTAL CONSENT AND EMERGENCY MEDICAL RELEASE FORM

The requested information on this form MUST be filled in completely for the student to participate in PSR.
VBS
July 15th - 19th, 2024

I/We, the parent(s)/guardian(s) of the child do hereby give my/our permission and approval for my/our son/daughter/guardianship to participate in the Parish School of Religion Program from June 15th - 19th, 2024.

I/ We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone this event, other participants, All Saints, the Catholic Archdiocese of Atlanta, All Saints PSR, and any of the above-named parties’ representatives, successors, supervisors, sponsors, and/or organizers, for any injuries in connection with the outing/event (s) named above provided that said injuries are not the result of negligence. I/We hereby grant permission for the publication of group (two or more persons) photos taken at youth events.

I/We also give permission to seek any emergency care should my child be involved in any accident or be injured in any way during such events named above. I/We understand that in any such instance, all attempts will be made to contact the parent/guardian. In the event that I/we cannot be contacted, I/we hereby give permission to the attending physician to hospitalize, secure treatment for, and order injection, anesthesia, and/or surgery for my child, as named herein.

I also agree that I am legally responsible for all/any personal actions taken by my child/guardianship during this event, and agree to be financially responsible for any/all damages, legal fees, and other costs incurred as a result of the actions/behavior of my child/guardianship.

Furthermore, I/we agree that if the above-named student’s behavior is inappropriate, unsafe, and/or detrimental to the group, I will be contacted immediately to secure means of removing my child/guardianship from the event premises. I understand that any financial costs incurred as a result of my child/guardianship being sent home are my responsibility.

Signature of Parent or Legal Guardian *

Clear

MEDIA RELEASE FORM

Our parish, All Saints Catholic Church, uses images, interviews, and videos of our children for a variety of internal and external communications. Our forms of internal and external communications include but are not limited to: print, such as newspapers, bulletins, and newsletters; photographs and digital images; film and videos; web posts, web pages, and image carousels; social networking platforms including but not limited to Facebook, Twitter,
and Instagram.

We follow the Archdiocese of Atlanta’s Social Media Policy and Guidelines for the Use of Social Networking Sites with
Minors. Please see this resource for more information.

Please indicate below whether our parish and/or school has permission to circulate interviews, images, and/or videos of your child for all parish and/or school events for one year: *

*

NO, I do not want my child included in, nor my child’s image used, in any internal or external communications.

I hereby grant permission for the following parish, All Saints Catholic Church, to use images and interviews of my child and/or children, for internal or external communications for one year.

My child may be photographed and/or interviewed for The Georgia Bulletin, and other media outlets. I understand content may be reprinted in The Georgia Bulletin or other media for public dissemination, including but not limited to film; video; television; radio; newspapers such as The Atlanta Journal and Constitution; websites and online platforms; and social media networks including but not limited to Facebook, Twitter, and Instagram. I release and relieve the parish and/or school, and the Archdiocese of Atlanta, from any responsibility or liability for any claims arising from the publication or reproduction of any photographs or interview in any news or other media. I waive any and all right to inspect or approve the finished images, video, or printed matter that may be used in conjunction with any image or video, or to approve the eventual use for which it may be applied. I understand that photographs, videos, and/or interviews are being done with the knowledge and approval of the parish and/or school, and that a signed release form is required for every participating individual.

Signature of Parent or Legal Guardian *

Clear

Date *

MM / DD / YYYY

Parent / Guardian Information

Non-Parent Emergency Contact

Child # 1

Child # 2

Child # 3

Child # 4

Payment Information:

Payment Plan Information

PARENTAL CONSENT AND EMERGENCY MEDICAL RELEASE FORM

MEDIA RELEASE FORM

The Medical Release, Parental Consent, and Media are good for the period of one year.