Vacation Bible Camp 2022

Main Contact Email Address REQUIRED

Primary method of communication

Please fill out this field. Please enter an email address.

Family Information

Family Last Name REQUIRED Please fill out this field. Please enter valid data.
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.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Emergency Contact (first and last name) REQUIRED Please fill out this field. Please enter valid data.
Emergency Phone REQUIRED Please fill out this field. Please enter valid data.
Alternate Pickup (first and last name) REQUIRED Please fill out this field. Please enter valid data.
Alternate Pickup phone REQUIRED Please fill out this field. Please enter valid data.

I give St. Mary Church my permission for Use of Photos to be used on St. Mary Website REQUIRED Please fill out this field.

Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (names above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Yes/No REQUIRED Please fill out this field.

Would you like to be a volunteer? REQUIRED YES! So happy you asked! Sorry, I can't this year Please fill out this field.

Deadline to register is June 13th to be guaranteed a T-shirt
Grades Kindergarten - 5th
Cost $40.00/Child
$20.00 per additional child in Household
Late registration and walk ups will be welcome but no t-shirt will be provided

Please either Mail a check or bring a check to the office

St. Mary Mother of the Church
419 Doucet Road
Lafayette, LA 70503

Vacation Bible Camp 2022

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