Family Name:
 Address:          Town:        ZIP:
 Phone:          Emergency Phone:                
 e-Mail
 Questions or Comments: 

 NOTE: School Grade as of September 2008...
           Student's Name for Name Button

 Student’s Name:   Grade: Select 4yr K 1 2 3 4 5       T-Shirt:  Select Size S(6-8) M(10-12) L(14-16) Adult Sm Adult Med Adult Large Adult XL Adult XXL  
    Any allergies:     Food:*   Other:
    Any additional medical information we need to know:

 Student’s Name:   Grade: Select 4yr K 1 2 3 4 5        T-Shirt:  Select Size S(6-8) M(10-12) L(14-16) Adult Sm Adult Med Adult Large Adult XL Adult XXL
    Any allergies:   Food:*   Other:
    Any additional medical information we need to know:

 Student’s Name:   Grade:* Select 4yr K 1 2 3 4 5        T-Shirt:  Select Size S(6-8) M(10-12) L(14-16) Adult Sm Adult Med Adult Large Adult XL Adult XXL  
    Any allergies:   Food:   Other:
    Any additional medical information we need to know:

 Student’s Name:    Grade:* Select 4yr K 1 2 3 4 5       T-Shirt:  Select Size S(6-8) M(10-12) L(14-16) Adult Sm Adult Med Adult Large Adult XL Adult XXL  
    Any allergies:   Food:   Other:
    Any additional medical information we need to know:

Pediatrician’s Name: Phone:

* We will not have any peanut products but parents please note if your child has several severe food allergies we are asking you to provide your child’s snack each day in a brown paper bag marked with their name and grade.

PARENTS: Please, Can you help?  Yes    No Name: Phone:
                    One or more days:   Mon.   Tues.   Wed.  Thurs.  

Mail your payment  or return this form and payment to:

Saint Louis VBS  
64 South Main St.  
Pittsford, NY   14534

Checks made payable to St. Louis Church

Absolute sign-up deadline is June 2^nd,
registrations will not be accepted after this date.