The Lamb of God
OUR LADY OF MERCY
(530) 222-3424
July 10-14, 2023;  8:30-12:30pm

Registration Form

Child’s Name_________________________________  Gender___________
 Age_______ Date of Birth_____________Last school grade completed____
Name of Parents_____________________________________________________
Street Address ______________________________________________________
City__________________________ State_________ Zip_____________________
Home Telephone_____________________ Cell Phone______________________
Email Address_______________________________________________________
Home Parish ________________________________________________________

Allergies or other medical conditions ____________________________________
In case of emergency, contact _________________________________________ 
Home Telephone______________________Cell Phone_____________________
Relationship to child_________________________________________________

Photo release
 I hereby grant Our Lady of Mercy, and it’s employees or volunteers, the right to photograph my child/dependent for activities during Vacation Bible School week and to advertise for VBS in the future at Our Lady of Mercy.

 I do not give my permission to have my child’s/dependent’s picture taken.

Registration Fees are $5 per child.  
T- Shirts are $9:     Child S ____,  Med_____,  Lg_____   
Adult S____,  Med____, Lg ____,  XLG ____

Signature__________________________________________ Date___________