Registration for SCUBA VBS 2024 @ St Cuthbert

July 15-18 from 9:00am to Noon | Please complete all fields to register your child for our Summer 2024 VBS program. Please submit a separate registration for each child.

Parent Name

*

Phone

*

Email

*

This address will receive a confirmation email

Address

*

Child Name and Birthday

*

2024-2025 Grade Level

*

Please select one option.

Pre-School (ages 3-4) K 1 2 3 4 5

Shirt Size (unisex)

*

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

Does your child have any special needs/allergies we should be aware of?

*

Child #2 Name and Birthday

2024-2025 Grade Level

Please select one option.

Pre-School (ages 3-4) K 1 2 3 4 5

Shirt Size (unisex)

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

Does your child have any special needs/allergies we should be aware of?

Child #3 Name and Birthday

2024-2025 Grade Level

Please select one option.

Pre-School (ages 3-4) K 1 2 3 4 5

Shirt Size (unisex)

Please select one option.

Youth Small Youth Medium Youth Large Adult Large Adult Medium Adult Large Adult XL

Does your child have any special needs/allergies we should be aware of?

Please Note: A parent must stay with any child that requires one-on-one care.

Emergency Contact Name(s), Phone Number(s) and Relationship.

*

If paying by cash or check, please choose the Cash/Check $0 option in the drop down menu.

Payment $20 per child

One Child ($20) Two Children ($40) Three Children ($60) Pay by Check/Cash ($0)

Amount

If you have more than three children, please fill out a separate form.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

July 15-18 from 9:00am to Noon

Please complete all fields to register your child for our Summer 2024 VBS program. Please submit a separate registration for each child.

Please Fix the Following

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