31 Prospect St, Brewster NY 10509 |
(845) 279-2021
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Programs & Info
VBS 2022
Fee: $175 per Child
Please be sure to also scroll down and register
Child 1
Child's Name
First Name*
Last Name*
Age as of July 2022
Required*
Entering Grade Sept 2022
Required*
Any Allergies?
Required*
T-Shirt Size
Required*
Please make a selection
Small
Medium
Large
X-Large
Is this child registered for Family Program?
Required*
Please make a selection
Yes
No
Child 2
Child's Name
First Name
Last Name
Age as of July 2022
Entering Grade Sept 2022
Any Allergies?
T-Shirt Size
Please make a selection
Small
Medium
Large
X-Large
Is this child registered for Family Program?
Please make a selection
Yes
No
Child 3
Child's Name
First Name
Last Name
Age as of July 2022
Entering Grade Sept 2022
Any Allergies?
T-Shirt Size
Please make a selection
Small
Medium
Large
X-Large
Is this child registered for Family Program?
Please make a selection
Yes
No
Mother's/Guardian's Information
Name
First Name*
Last Name*
Cell Phone to receive notification texts
Required*
-
-
Please select if...
"Use only this number for Text Notifications"
Home phone number (optional)
-
-
Home Address
Street 1*
Street 2
City*
State*
-- select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip*
Email Address
Required*
Are you’re a registered parishioner at St. Lawrence or Sacred Heart?
Required*
Please make a selection
Yes
No
Father's Information
Name
First Name
Last Name
Cell Phone to receive notification texts
-
-
Please select if...
"Use only this number for Text Notifications"
Home phone number (optional)
-
-
Please check if ...
Home Phone Same as Mother
Home Address
Street 1
Street 2
City
State
-- select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip
Please check if...
Home Address Same as Mother
E-mail Address
Are you’re a registered parishioner at St. Lawrence or Sacred Heart?
Please make a selection
Yes
No
Who is allowed to pick-up your child?
Name
First Name
Last Name
Cell Phone
-
-
Name
First Name
Last Name
Cell Phone
-
-
Name
First Name
Last Name
Cell Phone
-
-
Who is NOT allowed to pick-up your child?
Name
First Name
Last Name
Cell Phone
-
-
Name
First Name
Last Name
Cell Phone
-
-
Name
First Name
Last Name
Cell Phone
-
-
Emergency Information
If your child carries an EpiPen, leaves us a note here
In case your child is injured and we cannot contact you, we will call 911 and take your child to the nearest hospital.
Required*
"yes" confirmation of this statement
Additional Note on Health Concerns:
Comments
Parent/Guardian Signature
Date
Required*
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Checking this box serves as your signature
Required*
Parent/Guardian Signature
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