Vacation Bible School

Looking for Adult and high school volunteers!

Register below - Payment may be made online, at the MBVM Church Offices or sent through the McNamara Offices in envelope marked "VBS."

Checks should be made to : MATERNITY BVM CHURCH

contact Maria Pallissard - mpallissard@mbvm.org

Family Last Name
Address, city, state, zip code
Parents Name(s)
Parents Email
Parent cell phone
Phone to call DURING Vacation Bible School
Secondary emergency contact and phone number

: Registration for students entering grades 1st - 6th here:
(Grades 1st-4th are participants)
(Grades 5th and 6th are Jr. Leaders)
Student #1 Full Name
Grade entering 2024-2025
Allergies or Medical Conditions?
Student #2- Full Name
Grade entering 2024-2025
Allergies or Medical Conditions?
Student #3 - Full Name
Grade entering 2024-2025
Allergies or Medical Conditions?

: Volunteer Students - entering grades 7th on up can register to volunteer here:
Volunteer #1 Full Name
Grade entering 2024-2025
Allergies or Medical Conditions?
Volunteer #2 Full Name
Grade entering 2024-2025
Allergies or Medical Conditions?

: Medical Insurance information in case of emergency
Policy in the name of
Name of Insurance Company
Physician name
Physician phone number

Adult Volunteers - Are you as a parent or grandparent able to volunteer?: YesNoI can donate food (someone will reach out to you with needs)

Authorizations: Medical Authorization: By checking this box I grant permission for the administration of First Aid to the participant by the people in charge of Maternity BVM VBS as their judgement deems advisable, and to make the necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature. I understand that I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of medical emergency, I understand that every effort will be made to contact the emergency contact of the participant. In the event that I cannot be reached, I hereby give permission to the physicians selected by the adult staff/volunteer to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed necessary for the child.Hold Harmless: By checking this box, I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend Maternity BVM, the Diocese of Joliet, its officers, directors, agents, employees, or representatives from any and all liability for illness or death arising from on in connection with my participation in MBVM events. In the event that I should require medical treatment and I am not able to communicate my desires to attend physicians or other medical personnel, I give permission for the necessary treatment to be administered.Use of Photographs/Videos for Marketing Purposes Permissions Videos and or/photos may be taken during this event. By checking this box I give permission to use the participants image in video and/or photos which may be used for future promotional efforts.

Vacation Bible School

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