Vacation Bible School Registration Application | SUMMER 2022

: Vacation Bible School Registration Application | SUMMER 2022
: Vacation Bible School (VBS) will be held June 14-16, 2022 from 5:30PM-7:30PM in the Parish Activity Center at Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR).

VBS is free to our Parish School of Religion (PSR) students who were enrolled in Pre-K/Kindergarten-6th Grade during the 2021-2022 PSR Year.

All Campers must be signed in/out and escorted in/out by an authorized chaperone every day of VBS.

The information submitted on this application is considered confidential. The information will be used for the sole purposes of ICCC-BR, its PSR, and the Diocese of Baton Rouge's Office of Child and Youth Protection.

: CAMPER'S INFORMATION
First Name
Last Name
Gender
Date of Birth (MM/DD/YYYY)
Home Address (Include Apartment Number, If Applicable)
City/State/Zip Code
Grade (2021-2022 Academic Year)
Food/Drink Allergies (Identify All)
Identify "Other" (If Applicable)

: PRIMARY PARENT/LEGAL GUARDIAN'S INFORMATION
Relationship to Camper
First Name
Last Name
Preferred Contact Number (Include Area Code)
Type of Contact Number
Preferred Email Address

: EMERGENCY CONTACT'S INFORMATION
Relationship to Camper
Identify "Other" (If Applicable)
Preferred Contact Number (Include Area Code)
Type of Contact Number
Preferred Email Address

: LIABILITY WAIVER
As the Primary Parent or Legal Guardian, I waive, release and discharge the pastor, employees and volunteers of Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR) and its Vacation Bible School (VBS) from any and all liability that may arise from illness, negligence or personal injury/death to my child (i.e., Camper), and any property damage/theft to my child's (i.e., Camper's) belongings while he/she is on the premises of ICCC-BR and before/during/after any VBS activities.: Yes, I agree to the terms of the above Liability Waiver.

: PHOTO/VIDEO RELEASE
As the Primary Parent or Legal Guardian, I give permission to the employees and/or volunteers of Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR) and its Vacation Bible School (VBS) to take, display and post VBS-related photos and/or videos of my child (i.e., Camper) to ICCC-BR's website, Facebook page and inside its buildings. All VBS-related photos and/or videos will be considered ICCC-BR property, and will be used/displayed with discretion and appropriateness.: Yes, I agree to the terms of the above Photo/Video Release.No, I do not agree to the terms of the above Photo/Video Release.

: COVID-19 Safety Precautions
: Due to the possible spread of COVID-19, all Campers, chaperones, Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR) employees, Vacation Bible School (VBS) volunteers and other authorized persons are required to wear a face mask and to use hand sanitizer during VBS hours of operation.

During assigned VBS meal times, Campers are allowed to remove their face masks to eat and drink but must socially distance.

If a Camper, Primary Parent/Legal Guardian, chaperone, ICCC-BR employee or VBS volunteer knows or suspects that he/she has contracted or has been exposed to COVID-19, he/she must quarantine, must cease attending VBS and cannot enter any ICCC-BR buildings.

Disposable face masks and industrial-strength hand sanitizer will be available at all times inside the Parish Activity Center.

: Please click the "I'M NOT A ROBOT" and "SUBMIT" buttons before exiting this application. Thank you!

Vacation Bible School Registration Application | SUMMER 2022

Vacation Bible School Registration Application | SUMMER 2022

CAMPER'S INFORMATION

PRIMARY PARENT/LEGAL GUARDIAN'S INFORMATION

EMERGENCY CONTACT'S INFORMATION

LIABILITY WAIVER

PHOTO/VIDEO RELEASE

COVID-19 Safety Precautions

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