Rainforest Adventure Registration Form

July 14^th-18^th 9:00 AM-Noon

Registration Fee: $30 per child per week, $50 per family

Completed form should be sent to:

Pat Policastro

Our Lady of Fatima Church

2216 Rosa Road, Schenectady, NY 12309

Child’s Name: ____________________________________________

Parent/Guardian Name: _____________________________________

Address: ________________________________________________

Home telephone: ______________ Cell phone: ___________________

Child’s age: _____ Last school grade completed: _______

Home parish: __________________________________

In case of emergency during VBS (when the parent/guardian cannot be reached) please contact:

Name/ Relationship to child: ______________________________

Phone: ______________________

Please list anything (including food allergies) the VBS staff should be aware of:

___________________________________________________________

Person responsible for picking up this child at the end of each VBS day (if different from parent):

Name: ____________________________________________________

Telephone number: ____________________________

Signature of parent/guardian: ______________________________