St. Monica Catholic Church

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STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

St. Monica VBS 2020: Playing for God's Team
Helping children know and love Jesus in Word and Sacrament

June 15-19, 2020

English 9:00 a.m. to 12:00 noon

Morning English Session

Registration

Qty

Description

Amount

Total

Child Registration(s)

$35.00

---

CD of music used during VBS

$5.00

---

(optional purchase)

Total: $0.00

Camper Information

Camper 1 First Name: *

Last Name: *

What grade is your child entering in the fall? *

(for 2020-2021 school year)

Gender: *

T-Shirt Size: *

Does your child have Special Needs? *

Other:

If this does not apply, enter "None."

Does your child have any special dietary needs? *

Camper 2 First Name: *

Last Name: *

What grade is your child entering in the fall? *

(for 2020-2021 school year)

Gender: *

T-Shirt Size: *

Does your child have special needs? *

Other:

If this does not apply, enter "None."

Does your child have any special dietary needs? *

Emergency Contact Information

Emergency Contact #1: *

Emergency Contact Phone: *

Emergency Contact: #2: *

Emergency Contact Phone: *

Parent/Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Cell phone: *

E-mail: *

A receipt will be e-mailed to this address.

My child(ren) will be picked up by: *

If someone else, list name/phone below.

Name/Phone:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *

Name on Account: *

Routing Number: *

Account Number: *