St. Michael the Archangel, Garland
VBS Registration 2025 - Student - Step 1 of 2

St. Michael VBS Registration Form
June 9-13, 2025 | 8AM-12PM

Parishioner Registration Fee (NOW - 5/10)

1 child: $55 | $40/additional child
*Non-parishioners, please add $10 per child.*

Late Registration (5/11 - 5/31): Please add $10 per child.

*Please Note: A form must be filled out for every child.*

PAYMENT OPTIONS (Step 2 of 2):
-Cash (Turn in to the Faith Formation Office)
-Check (Turn in to the Faith Formation Office)

Payable to "St. Michael Garland"

Memo: Child(ren)'s name(s)

-Online: https://secure.myvanco.com/L-Z4TN/campaign/C-12BHR

1) Type in the amount due, select "One time" and press "continue" to enter your payment information.
2) Send payment confirmation to MelaniaR@stmichaelgarland.org OR print out payment confirmation and turn in to the Faith Formation office. Please include child(ren)'s name(s) in the subject line of all emails.

*Please Note: Your registration is not complete until both steps have been completed.*

Any questions? Please contact the Parish Office at 972-279-6581.

Participant Information (Youth/Child)

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Nickname (if different than First Name) Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
School Grade for Incoming School Year (2025/2026) REQUIRED Please fill out this field.
T-Shirt Size REQUIRED Please fill out this field.
Participant Cell Phone Number (if applicable) Maximum 20 characters Please enter a phone number.
Participant Email (if applicable) Please enter an email address.
The contact information listed on this registration form may be used for communication with parent/guardians and/or minor participants regarding this event. Parents will be copied in communications to minors.

Participant Household Information

Home Address 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.
Home Phone Number REQUIRED Maximum 20 characters
If none, list primary parent cell number.
Please fill out this field. Please enter a phone number.

Parent Information

Name of Parent/Guardian 1 REQUIRED Please fill out this field. Please enter valid data.
Title of Parent/Guardian 1 REQUIRED Please fill out this field.
Parent 1: Cell Number REQUIRED Maximum 20 characters
If none, list home number.
Please fill out this field. Please enter a phone number.
Parent 1: Secondary Phone Number Maximum 20 characters Please enter a phone number.
Parent 1: Email Address REQUIRED Please fill out this field. Please enter an email address.
Name of Parent/Guardian 2 Please enter valid data.
Title of Parent/Guardian 2
Parent 2: Cell Number Maximum 20 characters Please enter a phone number.
Parent 2: Secondary Phone Number Maximum 20 characters Please enter a phone number.
Parent 2: Email Address Please enter an email address.
The contact information listed on this registration may be used for communication with parent/guardians and/or youth participants regarding this event. Parents will be copied in communications with minors.

Emergency Contacts

Name of Additional Emergency Contact Please enter valid data.
Relationship of Additional Emergency Contact to Child Please enter valid data.
Phone Number of Additional Emergency Contact Maximum 20 characters Please enter a phone number.

Medical & Medication Information

Food Allergies or Dietary Restrictions - Describe any food related allergy, reactions, seriousness & management. Also include dietary restrictions.
List any medical conditions, physical restrictions, recent surgeries, learning challenges, behavioral conditions, or social concerns (depression, anxiety, etc.)
MEDICATIONS NOTES: All participants (minors) should bring their own regularly taken medications, and such medications should be clearly labeled. I understand that my child will be required to turn all prescription and non-prescription medication(s) over to a supervising adult designated to keep medication(s). I further understand that it will be this child's responsibility to present himself/herself at a location designated for returning medication(s) to this child at the frequencies/times described when turning in the medications. I understand that the adult to whom this child surrenders the medication has no medical training and this adult will not measure dosages. This child will return the medication(s) to the adult after he/she self-medicates. At the conclusion of the event it will be this child's responsibility to pick up remaining medication(s), if any, at the self-medication designated location. If the child is unable to self-medicate (measure dosages), the child's parent/guardian will attend the event/session and provide and dispense any needed medication(s).
Medication Use and Permission REQUIRED My Child TAKES NO medication(s) at this time and will not bring medication(s). My Child TAKES medication(s) BUT WILL NOT MEDICATE DURING event/session. My Child TAKES medication(s) and WILL BRING any necessary medication(s) - see medication notes. Please fill out this field.
Prescription Medications the Participant Currently Takes (Please revise updates at event/session check-in.)
I GRANT permission for these nonprescription Over-the-Counter (OTC) medications to be given to this child: Non-Aspirin/Pain Reliever, Throat Lozenge, Decongestant, Antacid, Antihistamine, Diarrheal, and Others as needed.

NOTE FOR LIMITING OTC MEDS:
- If there are particular OTC meds this child MAY NOT receive, list them below.
- If NO OTC meds should be administered to this child (unless the situation is life-threatening and emergency) write "Do Not Administer Any OTC Meds" below.
Over the Counter (OTC) Non-Prescription Medications your child MAY NOT RECEIVE: REQUIRED
If all OTC medications are acceptable, write "NONE". Otherwise, list any OTC meds your child MAY NOT receive or write "Do Not Administer Any OTC Meds".
Please fill out this field.
Should your child have an Emergency Injection Device (Epi-Pen), Diabetic Condition, asthmatics with a rescue inhaler, or other special medical condition, it is important to provide a clear description as to the nature of the medical condition and any medication. This is important for situations where the child becomes unable to self-administer these treatments and to communicate with Emergency Response Personnel. If a child, who is normally able to self-administer these medications becomes unable to self-administer or is in distress, youth ministers, volunteers, or other parish personnel will immediately call 911 to summon Emergency Medical Personnel to respond to the medical emergency. Youth ministers, volunteers, and other parish personnel are NOT trained to administer these types of emergency medications.

Insurance Information (if applicable)

Insurance Carrier Please enter valid data.
Policy Number Please enter valid data.
Insurance ID Number Please enter valid data.

Consents & Waivers

CONSENT TO PARTICIPATE AND LIABILITY RELEASE
I, the parent(s)/guardian(s)/conservator(s) of Child Participant grant permission for my son/daughter listed in this permission form to participate in the parish event and youth activities described on this permission form.
In consideration for allowing Youth to participate in youth activities and functions, in-person and/or via virtual meeting. I/we, the parent(s)/guardian(s)/conservator(s) of Youth, grant permission for Youth to travel to and participate in youth events and activities. I/we assume all risks and hazards incidental to Youth's participation in the Event, including transportation to and from the Event. In consideration for allowing Youth to participate in the event listed above, and on behalf of myself/ourselves and Youth's parents, legal guardians, siblings, heirs, assigns, and personal representatives, I/we hereby release and agree to fully and unconditionally protect, indemnify, and defend the Parish, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, "Indemnitees") and hold each Indemnitee harmless from and against any and all costs, expenses, attorney's fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Youth) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to Youth's participation in youth events and activities, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES. In the event any legal action is taken by either party against the other party to enforce any of the terms and conditions of this release, it is agreed that the unsuccessful party to such action shall pay to the prevailing party therein all reasonable court costs, attorney's fees, and expenses incurred by the prevailing party.
I HAVE READ AND UNDERSTAND THE CONSENT TO PARTICIPATE AND LIABILITY RELEASE.
I Agree Please select this field.
AUTHORIZATION OF CONSENT TO TREAT MINOR
I/We, the parent(s)/guardian(s)/conservator(s) of the minor(s) being registered do hereby authorize the parish(es) and /or diocese leading the Event/Program described for this registration, its ministry leaders, employees, contractors and volunteers as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the laws of the jurisdiction where such diagnosis or treatment may be given, whether such diagnosis or treatment is rendered at the office of said physician, at a hospital, or at any other location. It is understood that this authorization is given in advance of any specific treatment or diagnosis, but is given to provide authority and power of treatment, or hospital care which the aforementioned physician in the exercise of best judgment may deem advisable. This authorization is given pursuant to the provisions of Chapter 32 of the Texas Family Code. This authorization shall remain effective throughout the specific event dates listed above. In consideration of acceptance of this authorization, but without any time limitation and without any future right of revocation, I hereby release, defend and hold harmless the Parish and Roman Catholic Diocese of Dallas (Diocese), their officers, directors, agents, employees, volunteers, youth ministry leaders, and contractors from all claims, liabilities and loss in any way arising out of or in connection with or relating to such treatment and treatment decisions.
I HAVE READ AND UNDERSTAND THE AUTHORIZATION OF CONSENT TO TREAT MINOR
I Agree Please select this field.
AUDIO/VISUAL RECORDING & PHOTOGRAPHY CONSENT
On occasion, video recordings, audio recordings, photographic slides, and photographs are taken of children and youth during church and diocesan sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements and other printed media. For good and valuable consideration, I hereby grant to the parish(es) &/or diocese leading the registering Event the irrevocable and unrestricted right to make, use and/or publish any and all photographs, videos, and other images of me/my minor child(ren) listed on this registration form, or images in which me/my minor child may be included, now existing or hereafter made, in any case, with or without identifying subject for editorial, advertising, news, or any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. I hereby release and agree to fully and unconditionally protect, indemnify, and defend any parish(es) described on this registration form, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Childs) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to the use or publication of any photographs, videos, or other images of my child, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE, OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES.
I HAVE READ AND UNDERSTAND THE AUDIO/VISUAL RECORDING & PHOTOGRAPHY CONSENT
I Agree Please select this field.

CODE OF CONDUCT FOR ALL REGISTERED PARTICIPANTS

1. Every child/youth and adult will treat each other with respect, and conduct themselves in a manner that positively represents our Parish/Diocesan Community and the Catholic Church. Respect includes verbal exchanges, physical and psychological exchanges as well. Inappropriate displays of affection as well as any abuse of another person will not be tolerated.

2. Participants must attend all event activities. If provided, name badges must be worn at all times during the event.

3. Any drug, alcohol, tobacco, or illegal substance abuse will not be tolerated and will result in removal from the event, a possible ineligibility to participate in other ministry events, or may even include legal ramifications. Adults and youth will abide by all laws (vandalizing property damage, weapons, stealing, etc.) and will be held responsible for breaking these laws and for any damages. No weapon of any kind may be possessed by participants.

4. Adult leaders and chaperones have been given the authority to maintain safety and adherence to this Code of Conduct. Please give them your respect and cooperation.

5. Parents have the duty to review this code of conduct with their child. Parents agree that their child shall abide by regulations outlined in this Code and at the event. If their child fails to abide by the Code that child may be immediately dismissed from the event and sent home immediately at the parent’s expense, with no right of reimbursement for any amount in connection therewith.
I HAVE READ AND UNDERSTAND THE CODE OF CONDUCT.
I Agree Please select this field.

Parental Consent & Electronic Signature

CIVIL AUTHORITY ACKNOWLEDGEMENT

I confirm I am a legal parent/guardian/conservator and have the civil authority to arrange sacramental preparation and spiritual formation for the minor(s) named on this form.

This electronic signature cannot be completed by minor under the age of 18 but must be completed by parent, legal guardian or conservator of a minor, individuals over the age of 18, or by a ministry leader inputting data from a paper consent form already completed by a parent or guardian and kept on file. If you are under the age of 18, you MAY NOT complete this section. Ask your parent or guardian to complete it for you.
Name of Person Giving Consents and Agreeing to Consent Terms REQUIRED Please fill out this field. Please enter valid data.
Signer Type REQUIRED Parent/Guardian/Conservator of the Child Ministry leader inputting data from a paper consent completed by a parent/guardian Self - if over the age of 18 Please fill out this field.
To better authenticate a unique electronic signature, we ask you to enter the last four digits of your social security number OR driver’s license number OR other government issued ID#. If you do not have one of these numbers, ask your ministry leader for a paper registration form or an alternative PIN number.*
Last Four Digits of Government Issued ID# REQUIRED Please fill out this field. Please enter valid data.
Type of ID REQUIRED Please fill out this field.

Please list three people and their phone numbers who are authorized to pick up your child.

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.
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.
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.

Child's Full Name REQUIRED Please fill out this field. Please enter valid data.

Parent's Email Address REQUIRED Please fill out this field. Please enter an email address.

Parent's Full Name REQUIRED Please fill out this field. Please enter valid data.

Parent Signature REQUIRED Please fill out this field. Please enter valid data.

St. Michael -Garland 972-279-6581

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VBS Student Registration

VBS Student Registration - 2025

St. Michael the Archangel, Garland
VBS Registration 2025 - Student - Step 1 of 2

St. Michael VBS Registration Form
June 9-13, 2025 | 8AM-12PM

The contact information listed on this registration form may be used for communication with parent/guardians and/or minor participants regarding this event. Parents will be copied in communications to minors.

The contact information listed on this registration may be used for communication with parent/guardians and/or youth participants regarding this event. Parents will be copied in communications with minors.

I GRANT permission for these nonprescription Over-the-Counter (OTC) medications to be given to this child: Non-Aspirin/Pain Reliever, Throat Lozenge, Decongestant, Antacid, Antihistamine, Diarrheal, and Others as needed.

NOTE FOR LIMITING OTC MEDS:

If there are particular OTC meds this child MAY NOT receive, list them below.

If NO OTC meds should be administered to this child (unless the situation is life-threatening and emergency) write "Do Not Administer Any OTC Meds" below.

2. Participants must attend all event activities. If provided, name badges must be worn at all times during the event.

4. Adult leaders and chaperones have been given the authority to maintain safety and adherence to this Code of Conduct. Please give them your respect and cooperation.

VBS Student Registration

St. Michael the Archangel, GarlandVBS Registration 2025 - Student - Step 1 of 2

St. Michael VBS Registration FormJune 9-13, 2025 | 8AM-12PM

The contact information listed on this registration form may be used for communication with parent/guardians and/or minor participants regarding this event. Parents will be copied in communications to minors.

The contact information listed on this registration may be used for communication with parent/guardians and/or youth participants regarding this event. Parents will be copied in communications with minors.

I GRANT permission for these nonprescription Over-the-Counter (OTC) medications to be given to this child: Non-Aspirin/Pain Reliever, Throat Lozenge, Decongestant, Antacid, Antihistamine, Diarrheal, and Others as needed.NOTE FOR LIMITING OTC MEDS:

If there are particular OTC meds this child MAY NOT receive, list them below.

If NO OTC meds should be administered to this child (unless the situation is life-threatening and emergency) write "Do Not Administer Any OTC Meds" below.

2. Participants must attend all event activities. If provided, name badges must be worn at all times during the event.

4. Adult leaders and chaperones have been given the authority to maintain safety and adherence to this Code of Conduct. Please give them your respect and cooperation.

St. Michael the Archangel, Garland
VBS Registration 2025 - Student - Step 1 of 2

St. Michael VBS Registration Form
June 9-13, 2025 | 8AM-12PM

I GRANT permission for these nonprescription Over-the-Counter (OTC) medications to be given to this child: Non-Aspirin/Pain Reliever, Throat Lozenge, Decongestant, Antacid, Antihistamine, Diarrheal, and Others as needed.

NOTE FOR LIMITING OTC MEDS: