Vacation Bible School

VBS/Summer Programs Locations (may choose more than one) REQUIRED St. Ann, Waynesburg St. Hugh, Carmichaels St. Ignatius, Bobtown Sundays at St. Ann Please fill out this field.

Child's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Gender REQUIRED Please fill out this field.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Age REQUIRED Please fill out this field. Please enter valid data.
Grade Entering REQUIRED Please fill out this field. Please enter valid data.
For additional child:
First Name Please enter valid data.

Last Name Please enter valid data.
Gender
Date of Birth Please enter a date.
Age Please enter valid data.
Grade Entering Please enter valid data.
For 3 or more children, please submit another form as needed.
Medical Conditions / Food Allergies
- There is NO nurse or medical personnel onsite during VBS. Please note if child carries an EPI-pen or other medications.
- If child has a special diet, please pack his/her snack & deliver to church kitchen when he/she arrives at VBS each day. Thank you.
If a Teen Helper, select area of interest Classroom Helper Recreation/Games Crafts Music Snacks/Kitchen

If registering more than one teen, please note in "additional information" below his/her area of interest.
**Please note, the teen(s) may not get the selected area of interest. Volunteer assignments are based on a first come, first serve basis.
If you choose, you may select more than one area of interest to help in assigning you to your best fit area.

Parent / Guardian's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
First Name Please enter valid data.

Last Name Please enter valid data.
Relationship to child if NOT parent (i.e. grandparent) Please enter valid data.
Street REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Type REQUIRED Please fill out this field.
Phone Number Maximum 20 characters Please enter a phone number.
Type
Email REQUIRED Please fill out this field. Please enter an email address.
Family will be registered as members of St. Matthias Parish,
unless you note otherwise in "additional information" below
your family's membership (i.e. St. Francis of Assisi).

Emergency Contact (if unable to reach parent)

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Relationship to child REQUIRED Please fill out this field. Please enter valid data.

Person picking up child (if not parent)

First Name Please enter valid data.

Last Name Please enter valid data.
Phone Number Maximum 20 characters Please enter a phone number.
Relationship to child Please enter valid data.

Additional Information

Your family will be registered as members of St. Matthias Parish unless you note otherwise in "additional information" above your family's church membership (i.e. St. Francis of Assisi).

Photo Release

I give permission for my child/children to be photographed / video recorded and to use his/her name(s) in any printed or online publications by St. Matthias Parish and/or Pittsburgh Diocese. REQUIRED Yes No Please fill out this field.

Consent / Release

I understand that reasonable precautions will be taken to safeguard the health and well-being of the participants in the Religious Education programs of St. Matthias Parish 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 Religious Education staff, or other associated volunteers of the Religious Education programs 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 the Pittsburgh Diocese and St. Matthias Parish from all manners of actions, claims which I or my child/children named above shall or may have for any reason, arising during my child’s/children’s attendance at these Religious Education programs.

I Agree Please select this field.

Diocese of Pittsburgh - COVID Memo

~ COVID-19 symptoms & temperature screenings are be done by ALL parents/guardians at HOME before VBS.

~ NO child with symptoms should be brought to VBS. For more information on COVID-19, visit websites: CDC or PA.gov or DioPitt.org.

There is no registration fee, however, donations are greatly appreciated. Please make checks payable to St. Matthias VBS and mail to St. Matthias Parish, ATTN: Linette Kerr, 408 S Route 408, Carmichaels, PA 15320 OR give ONLINE (please select "Religious Education CCD"). Thank you.

VBS Donation Amount (Optional) $ Please enter a positive decimal.

St. Matthias Parish

408 S. Route 88, Carmichaels, PA 15320

Vacation Bible School

Locations, Dates & Times ~ 2022

How to Register for VBS

VBS Registration Form ~ St. Matthias Parish