Dates / Location: August 3-7, 2026 / St. Timothy Church, Warwick

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Child’s Information:

Name: _________________________________________________________________________

Gender:   M   F            Age: ____________           Grade completed: _____________

T-shirt size: (circle one)   child sizes :   XS    S   M   L       /    adult sizes:  S  M  L  XL

Religion:   _________ Roman Catholic              _________Other (please name)________________

Allergies or medical conditions: ______________________________________________________

If Catholic- Sacraments Received:  Baptism (Date)______________ (Parish)__________________

                                             First Communion (Date)_____________ (Parish)__________________

Are you interested in being an altar server at mass? (We will train you.)___________________

Are you interested in singing in the children’s choir at mass?______________________

Are you interested in playing an instrument at mass? ________ Which one? ___________________

Family Information:

Parent/Guardian Name: _____________________________________________________________

Address: ____________________________________   Email: _____________________________

Parish____________________________________________________________________________

Is there anyone in the family interested in becoming Catholic or needing to receive any sacraments?

_________________________________________________________________________________

_________________________________________________________________________________

Phone Numbers:

Home: __________________________         Cell: ____________________________

Emergency Contact:

Name: ____________________________________________  Phone: _______________________

I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge Cat.Chat Productions Inc., this Diocese, and this Parish from all manners of actions, claims which I or the child named above shall or may have for any reason, arising during my child’s attendance of the VBS.

Unless other written instruction is submitted, I also consent to allowing my child’s image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of Cat.Chat VBS programs.

Parent / Guardian Signature                                                                                                                      Date

Payments can be made by cash, checks made payable to Saint Timothy Church, or at our website for on-line giving at sainttimothy@weconnect.com in the ribbon at the top in green.

Received By______________________ Fee Paid _________