VBS Registration

Parent/Guardian 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.

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.

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

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Relationship to Child REQUIRED Please fill out this field. Please enter valid data.

Emergency Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Child Information

Number of Children Registering Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Child's Age REQUIRED Maximum 10 characters Please fill out this field. Please enter an integer (number) from 0 to 10.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade Entering in the Fall 2025 REQUIRED Pre-K4 K 1 2 3 4 Please fill out this field.
- Food Allergies REQUIRED YES NO Please fill out this field.
- Please, list any allergies your child may have. (If NO - write N/A) REQUIRED Please fill out this field. Please enter valid data.
- Medical Concern (if YES please, explain) REQUIRED Please fill out this field. Please enter valid data.
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Child's Age REQUIRED Maximum 10 characters Please fill out this field. Please enter an integer (number) from 0 to 10.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade Entering in the Fall 2025 REQUIRED Pre-K4 K 1 2 3 4 Please fill out this field.
- Food Allergies REQUIRED YES NO Please fill out this field.
- Please, list any allergies your child may have. (If NO - write N/A) REQUIRED Please fill out this field. Please enter valid data.
- Medical Concern (if YES please, explain) REQUIRED Please fill out this field. Please enter valid data.
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Child's Age REQUIRED Maximum 10 characters Please fill out this field. Please enter an integer (number) from 0 to 10.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade Entering in the Fall 2025 REQUIRED Pre-K4 K 1 2 3 4 Please fill out this field.
- Food Allergies REQUIRED YES NO Please fill out this field.
- Please, list any allergies your child may have. (If NO - write N/A) REQUIRED Please fill out this field. Please enter valid data.
- Medical Concern (if YES please, explain) REQUIRED Please fill out this field. Please enter valid data.
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Child's Age REQUIRED Maximum 10 characters Please fill out this field. Please enter an integer (number) from 0 to 10.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade Entering in the Fall 2025 REQUIRED Pre-K4 K 1 2 3 4 Please fill out this field.
- Food Allergies REQUIRED YES NO Please fill out this field.
- Please, list any allergies your child may have. (If NO - write N/A) REQUIRED Please fill out this field. Please enter valid data.
- Medical Concern (if YES please, explain) REQUIRED Please fill out this field. Please enter valid data.
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Child's Age REQUIRED Maximum 10 characters Please fill out this field. Please enter an integer (number) from 0 to 10.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Grade Entering in the Fall 2025 REQUIRED Pre-K4 K 1 2 3 4 Please fill out this field.
- Food Allergies REQUIRED YES NO Please fill out this field.
- Please, list any allergies your child may have. (If NO - write N/A) REQUIRED Please fill out this field. Please enter valid data.
- Medical Concern (if YES please, explain) REQUIRED Please fill out this field. Please enter valid data.

Permission to publish photo (no name) in the bulletin REQUIRED YES NO Please fill out this field.

I authorize the following adult to pick my child(ren) up from VBS: Please enter valid data.

I/we request that my/our son/daughter(s) attend the Vacation Bible School under the auspices of Our Lady of the Lake Church to be held on July 21-24, 2025. I/we have read the foregoing Health information/Release of Liability/Consent to Treat Form, and the answers are all correct. I/we can be reached at the telephone numbers referred to above, but if emergency medical care or treatment shall be necessary, and I/we cannot be contacted, I/we authorize the delegated agents of Our Lady of the Lake’s Staff to act on my/our behalf and approve appropriate treatment.
Release of Liability: The undersigned intends to participate in the Vacation Bible School, organized by Our Lady of the Lake Church. The undersigned hereby agrees to forfeit any and all claims against the Parish, the Bishop, the Diocese of Paterson, and its agents, servants, volunteers, and employees arising during or as a result of the afore mentioned activity. The undersigned hereby releases the Bishop, the Parish, the Diocese of Paterson, and its agents, servants, volunteers and employees from any and all liability, loss, cost, expense or damage, including suits, claims, and demands of every kind and nature, including punitive damages, arising out of or based upon any accident, injury, or damage, however occurring, which may happen on or off Our Lady of the Lake Church premises, which in any way relates to or arises from the undersigned’s participation in such off-Parish activity. The undersigned expressly releases Our Lady of the Lake, the Bishop, the Diocese of Paterson, and its agents, servants, volunteers, and employees from any and all liability, damage, or loss which may be occasioned by reason of any defect in any vehicle, or through the acts of default of any person or company engaged in conveying passengers, or in carrying out the arrangements of the event, including losses due to delays or changes in means of transportation.

I Agree Please select this field.

Our Lady of the Lake Parish

Sparta, NJ

Trusting Jesus in a Wild World!

Our Lady of the Lake Church

July 21-24, 2025

from 9:00 AM to 12:00 PM

Children entering Pre-K4 -4^th grade. Cost $50/child.