St. James Episcopal Church


	But be doers of the word, and not merely hearers who deceive themselves. James 1:22

Vacation Church School Registration Form

P.O. Box 126
Baton Rouge, LA 70821
(Corner of 4th and Florida)

Must be 3 yrs old (and potty- trained) through entering 5th Graders
$30 per child or $50 per family
Nursery available for siblings (under 4)
9am-12 noon $20/child
Make checks payable to St. James Episcopal Church and put VCS in the memo line. Return to church or school office
Payment is due the first day of church school

* - Required Fields

Children's Information

Child's Name:

Gender:

Age:

Entering Grade:

Allergies or Concerns:

T-Shirt Size:

Child's Name *:

Gender *:

Age *:

Entering Grade *:

Allergies or Concerns:

T-Shirt
Size *:

Parent's Information

Parent's Name *:
Address *:
City *: State *: Zip *:

Phone (home) *:
Phone (work):
Phone (cell) *:
Home Church:
Email Address *:
Emergency Contact *:
Doctor *:
Authorized to pick child(ren) up:		Parent Only Parent plus Authorized Persons, please list:
In case of an emergency, I give my permission for my child(ren) to be taken for medical treatment to a hospital or doctor.
I want to help, please contact me.