SAVE THE DATE!

The Brightest Week of the

Summer

New friends Amazing experiments

Spelunker Sports Lip-smacking snacks

Surprising adventures Incredible music

DATES/LOCATION: June 6-7, 2016 at St. Joseph’s, Wellman

TIMES: 8:30 a.m. – 3:30 p.m. (Lunch provided.)

For More Information, Call Anne Mann (319) 330-1057 or

Tina Peck (319) 530-9646

DATES/LOCATION: June 20-22, 2016 at St. Mary’s, Riverside

TIMES: 9:00 a.m. – 1:00 p.m. (Lunch provided.)

For More Information, Call Peggy Bush (319) 321-1071 or

Joyce Mattes (319) 936-7516

VACATION BIBLE SCHOOL FAMILY INFORMATION FORM

Preschool (4 years) through 5thgrade (middle school students may volunteer as assistants)

Family Name:

Address:

Street AddressCityStateZip

Parent/

Guardian #1NameAddress if different from abovePhone #

Parent/

Guardian #2NameAddress if different from abovePhone #

***********************************************************************

Child #1 _____ Yes No

NameAgeGrade (2016-17 school yr) Food Allergy

(If yes, please explain)

Child #2 _____ Yes No

NameAgeGrade (2016-17 school yr) Food Allergy

(If yes, please explain)

Child #3 _____ Yes No

NameAgeGrade (2016-17 school yr) Food Allergy

(If yes, please explain)

***********************************************************************

MEDICAL INFORMATION

Doctor:

Address:

Street AddressCityStateZipPhone

In case of an emergency, please contact:

NamePhone

Please list any Medical concerns or needs:

By signing the line below, I give permission for
my child to be photographed as part of the
Cave Quest Vacation Bible School
Parent/Guardian Signature / When leaving Vacation Bible School, my child:
may walk home
______will pick up my child(ren)

Parent / Guardian SignatureDate

My child/children will attend: St. Joseph’s Bible School ____ St. Mary’s Bible School_____

Return Completed Form to: St. Mary’s Church, PO Box C, Riverside, IA 52327; or Holy Trinity, c/o Joyce Mattes, PO Box 532, Kalona, IA 52247 or St. Joseph's Church, 210 11th St., Wellman, IA 52356