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2021 Parent Printable Covid & Medical Release Forms
Contact Us
Connie Whittington
Director of Children’s Ministry
(813) 949-2699
ConnieW
Ladyrosary.org
Monday, June 14—Friday, June 18, 2021
6:00 PM—8:30 PM
Completed Kindergarten—5th Grade
Registration begins April 11th.
Each child needs to be registered individually as we have limited spots available due to covid.
Please note a notarized Medical Release form is now required, if you are in need of a notary please let us know.
We look forward to seeing you in June!
Would you like to Volunteer?
Click Here to Volunteer
Registration Parent Flyer
The maximum number of form submissions has been reached. This form is currently not available.
I am a parishoner of Our Lady of the Rosary
REQUIRED
Yes
No
Please fill out this field.
I would like to reserve a copy of the music CD for an additional $10 which I will pick up and pay for at VBS on Tuesday or Wednesday.
REQUIRED
Yes
No
Please fill out this field.
Family Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Home Phone Number
Please enter a phone number.
Main Contact Email
REQUIRED
Please fill out this field.
Please enter an email address.
Home Address
REQUIRED
Please fill out this field.
Parent info
Father's Name
REQUIRED
Please fill out this field.
Please enter valid data.
Father's Email
REQUIRED
Please fill out this field.
Please enter an email address.
Father's Cell Number
REQUIRED
Please fill out this field.
Please enter a phone number.
Mother's Name
REQUIRED
Please fill out this field.
Please enter valid data.
Mother's Email
REQUIRED
Please fill out this field.
Please enter an email address.
Mother's Cell Number
REQUIRED
Please fill out this field.
Please enter a phone number.
Child #1 info
First Name
REQUIRED
Please fill out this field.
Please enter valid data.
Last Name
REQUIRED
Please fill out this field.
Please enter valid data.
Age
REQUIRED
Please fill out this field.
Please enter valid data.
Current Grade
REQUIRED
Please fill out this field.
Please enter valid data.
Sex
REQUIRED
Male
Female
Please fill out this field.
Crew Number
Please enter valid data.
T-Shirt Size
REQUIRED
(YXS, YS, YM, YL, AXS, AS, AM, AL, AXL, A2X, A3X)
Please fill out this field.
Please enter valid data.
Special Needs (Allergies-food, medical, physical):
Any special requests? (We’ll do our best to accommodate your request!)
Publicity Releases/Photo Form Policy Agreement
We want to share the awesome things that God is doing so that others are encouraged to bring their children to participate more fully in our life together as Christians! From time to time, we use photos and videos in parish media (website, bulletin, etc.) and in the local community (newspapers, website, etc.).
I give the following permission for my child's name and likeness to be included in such publicity releases.
REQUIRED
I DO give permission
I DO NOT give permission
Please fill out this field.
By typing my name on the line below, I understand I am consenting to the above through an e-signature
REQUIRED
Please fill out this field.
Please enter valid data.
Child #2 info
First Name
Please enter valid data.
Last Name
Please enter valid data.
Age
Please enter valid data.
Current Grade
Please enter valid data.
Sex
Male
Female
Crew Number
Please enter valid data.
T-Shirt Size
(YXS, YS, YM, YL, AXS, AS, AM, AL, AXL, A2X, A3X)
Please enter valid data.
Special Needs (Allergies-food, medical, physical):
Any special requests? (We’ll do our best to accommodate your request!)
Publicity Releases/Photo Form Policy Agreement
We want to share the awesome things that God is doing so that others are encouraged to bring their children to participate more fully in our life together as Christians! From time to time, we use photos and videos in parish media (website, bulletin, etc.) and in the local community (newspapers, website, etc.).
I give the following permission for my child's name and likeness to be included in such publicity releases.
I DO give permission
I DO NOT give permission
By typing my name on the line below, I understand I am consenting to the above through an e-signature
Please enter valid data.
Child #3 info
First Name
Please enter valid data.
Last Name
Please enter valid data.
Age
Please enter valid data.
Current Grade
Please enter valid data.
Sex
Male
Female
Crew Number
Please enter valid data.
T-Shirt Size
(YXS, YS, YM, YL, AXS, AS, AM, AL, AXL, A2X, A3X)
Please enter valid data.
Special Needs (Allergies-food, medical, physical):
Any special requests? (We’ll do our best to accommodate your request!)
Publicity Releases/Photo Form Policy Agreement
We want to share the awesome things that God is doing so that others are encouraged to bring their children to participate more fully in our life together as Christians! From time to time, we use photos and videos in parish media (website, bulletin, etc.) and in the local community (newspapers, website, etc.).
I give the following permission for my child's name and likeness to be included in such publicity releases.
I DO give permission
I DO NOT give permission
By typing my name on the line below, I understand I am consenting to the above through an e-signature
Please enter valid data.
Child #4 info
First Name
Please enter valid data.
Last Name
Please enter valid data.
Age
Please enter valid data.
Current Grade
Please enter valid data.
Sex
Male
Female
Crew Number
Please enter valid data.
T-Shirt Size
(YXS, YS, YM, YL, AXS, AS, AM, AL, AXL, A2X, A3X)
Please enter valid data.
Special Needs (Allergies-food, medical, physical):
Any special requests? (We’ll do our best to accommodate your request!)
Publicity Releases/Photo Form Policy Agreement
We want to share the awesome things that God is doing so that others are encouraged to bring their children to participate more fully in our life together as Christians! From time to time, we use photos and videos in parish media (website, bulletin, etc.) and in the local community (newspapers, website, etc.).
I give the following permission for my child's name and likeness to be included in such publicity releases.
I DO give permission
I DO NOT give permission
By typing my name on the line below, I understand I am consenting to the above through an e-signature
REQUIRED
Please fill out this field.
Please enter valid data.
Child #5 info
First Name
Please enter valid data.
Last Name
Please enter valid data.
Age
Please enter valid data.
Current Grade
Please enter valid data.
Sex
Male
Female
Crew Number
Please enter valid data.
T-Shirt Size
(YXS, YS, YM, YL, AXS, AS, AM, AL, AXL, A2X, A3X)
Please enter valid data.
Special Needs (Allergies-food, medical, physical):
Any special requests? (We’ll do our best to accommodate your request!)
Publicity Releases/Photo Form Policy Agreement
We want to share the awesome things that God is doing so that others are encouraged to bring their children to participate more fully in our life together as Christians! From time to time, we use photos and videos in parish media (website, bulletin, etc.) and in the local community (newspapers, website, etc.).
I give the following permission for my child's name and likeness to be included in such publicity releases.
I DO give permission
I DO NOT give permission
By typing my name on the line below, I understand I am consenting to the above through an e-signature
Please enter valid data.
Child #6 info
First Name
Please enter valid data.
Last Name
Please enter valid data.
Age
Please enter valid data.
Current Grade
Please enter valid data.
Sex
Male
Female
Crew Number
Please enter valid data.
T-Shirt Size
(YXS, YS, YM, YL, AXS, AS, AM, AL, AXL, A2X, A3X)
Please enter valid data.
Special Needs (Allergies-food, medical, physical):
Any special requests? (We’ll do our best to accommodate your request!)
Publicity Releases/Photo Form Policy Agreement
We want to share the awesome things that God is doing so that others are encouraged to bring their children to participate more fully in our life together as Christians! From time to time, we use photos and videos in parish media (website, bulletin, etc.) and in the local community (newspapers, website, etc.).
I give the following permission for my child's name and likeness to be included in such publicity releases.
I DO give permission
I DO NOT give permission
By typing my name on the line below, I understand I am consenting to the above through an e-signature
Please enter valid data.
Please list emergency contact information and those authorized to pick up children OTHER THAN above listing:
Who are you paying for?
REQUIRED
Please fill out this field.
REGISTRATION FEES – Space is limited. Payment reserves your spot. All are welcome!
If you need a full or partial scholarship simply email our Director (Conniew@ladyrosary.org).
REQUIRED
35.0
– One child
60.0
– Two or more children
0.0
– Multiple child registration (Please pay on first child registered, then use this field for additional children you need to register in the same family. Thank you!
0.0
– OLOR Staff (please use section below)
Please fill out this field.
For Employed Staff Members of Our Lady of the Rosary
$0.00 – None
$5.00 – 1 child
$10.00 – 2 children
$15.00 – 3 children
$20.00 – 4 children
NO REFUNDS
Registrants after May 16 will not receive T-Shirts
I understand there are 2 forms for EACH child (Covid & Medical Release) which I will need to print and fill out and turn in before my child can attend VBS. Forms will be available on the thank you confirmation page after payment is completed or in the document download section of this page.
I Agree
Please select this field.
Total:
Submit
Proceed to Payment
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