VBS Summer 2024

: Vacation Bible School Registration Application (Summer 2024)
: Vacation Bible School (VBS) will be held June 18-20, 2024 from 5:30PM-7:30PM in the Parish Activity Center at Immaculate Conception Catholic Church-Baton Rouge (ICCC-BR).

VBS is free to our church parish children ages 4-12 (Kindergarten-6th Grade).

All Campers must be signed in/out and escorted in/out by an authorized person 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 Parish School of Religion (PSR), and the Diocese of Baton Rouge's Office of Child and Youth Protection.

Please submit this application by Monday, June3, 2024.

: 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 (2023-2024 Academic Year)
Food/Drink Allergies (Identify All)
Identify "Other" (If Applicable)

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

: EMERGENCY CONTACT'S INFORMATION
First Name
Last Name
Relationship to Camper
Identify "Other" (If Applicable)
Contact Number (Include Area Code)
Type of Contact Number
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.

: AUTHORIZED PICK-UP PERSON(S)
: As a safety precaution, please identify the name(s) of each person who is authorized to pick-up your "precious cargo" at the end of each VBS day.
1. Authorized Pick-up Person | First and Last Name
Relationship to Camper
Identify "Other" (If Applicable)
2. Authorized Pick-up Person | First and Last Name
Relationship to Camper
Identify "Other" (If Applicable)

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

VBS Summer 2024

Vacation Bible School Registration Application (Summer 2024)

CAMPER'S INFORMATION

PRIMARY PARENT/LEGAL GUARDIAN'S INFORMATION

EMERGENCY CONTACT'S INFORMATION

LIABILITY WAIVER

PHOTO/VIDEO RELEASE

AUTHORIZED PICK-UP PERSON(S)

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