Child's Name*
Child's Age*
Grade in fall 2023* Pre-SchoolKindergarten1st2nd3rd4th5th
Tshirt Size* Youth X-SmallYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult Large
Home Address Street*
Home Address City*
Home Address State*
Home Address Zip*

Parent / Guardian Name*
Parent / Guardian Phone*
Parent / Guardian Email*
Parent / Guardian Alt Phone
Second Parent / Guardian Name
Second Parent / Guardian Phone
Second Parent / Guardian Email
Second Parent / Guardian Alt Phone

In Case of Emergency, notify*

Provide your family's Pick-Up Password (This will only be seen by your child’s teacher and the Registrar of VBS, and only those who know the password will be able to release your child.)

Please select if you would like to be contacted or would like more information about St. Patrick’s NoYes

Please select if you would like a scholarship for your child NoYes

When you hit "Submit" below you will be taken to Square where you can pay for each child.

There is also an option to donate an additional $20 for supplies.