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Participant Registration

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Registro en Español

CHURCH OF THE IMMACULATE CONCEPTION

Location

200 Ware Ave

Towson, MD 21204

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Contact Kristen Mumaw:

410-427-4726

kmumaw@theimmaculate.org

First, Tell Us About Yourself:

Parent Information

ATTENTION PARENTS: Thank you for registering your child for our VBS program at Immaculate Conception in Towson, Maryland! In addition to completing this registration page a payment will need to be submitted.

Please note, additional forms may be required before we begin. They will be emailed to you if necessary.

First Name

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Last Name

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Additional Parent/Guardian First Name

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Additional Parent/Guardian Last Name

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Home Church Affiliation

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Country

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Contact Phone 1

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Contact Phone 2

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Text Message Phone

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Alternate Pickup 2 Name

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Alternate Pickup 2 Phone

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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School attending in 2026-2027

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Grade Entering

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Gender

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Date Of Birth

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Shirt Size

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Friend 3 First Name

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Friend 3 Last Name

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Comments

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Allergies

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Medical Concerns

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My child is covered by hospitalization and medical insurance. Below list the policy number____________________ and who it is issued by _______________ OR STATE: My Child is NOT covered by hospitalization and medical insurance and I you assume responsibility for the cost of hospitalization and medical care for participant.

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I hereby grant permission to any “Parish” or Archdiocesan coach, athletic trainer, staff member, or volunteer to provide the following over-the-counter drugs (or their generic equivalent) to my Child if requested by my Child during the Activities, in accordance with dosage instructions provided on the corresponding drug’s packaging (check all that apply):

Multiple selections are allowed.

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I understand and agree that my Child will not be permitted to carry medication, whether over-the-counter drugs or otherwise, on my Child’s person during the Activities without prior notice to and approval from Kristen Mumaw. I further understand and agree that should my Child require certain medication during the Activities, I must complete and submit the Permission to Give Medication in Child Care Form to Kristen Mumaw prior to the start of the Activities. Type Electronic Signature Below

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Permission Release: Church of the Immaculate Conception Vacation Bible School 2026 WAIVER & RELEASE AGREEMENT FOR MINOR PARTICIPANT I hereby grant permission for my minor Child to participate in any and all activities associated Vacation Bible School (VBS) facilitated by Church of the Immaculate Conception “Parish”, whether on “Parish” premises or at off-site locations, including transportation to and from such locations, from July 27, 2026 to July 31, 2026 (collectively, the “Activities”). I have also reviewed and understand the accompanying description provided by the “Parish” describing the Activities in further detail. In consideration of the opportunity for my Child to participate in the Activities, I knowingly and voluntarily on behalf of myself and my Child do hereby agree to forever RELEASE, HOLD HARMLESS, AND INDEMNIFY the “Parish” and the Roman Catholic Archbishop of Baltimore, a Corporation Sole (the “Archdiocese of Baltimore”) and each of their affiliate organizations, agents, governing board, departments, employees, officers, directors, volunteers, officials, representatives, agents, insurers, students, and other participants in the Activities (collectively, the “Released Parties”) to the fullest extent permitted by law from any and all liability, claims, demands, and causes of action, including claims of negligence, arising out of or relating to any loss, damage, or injury (including illness or death) sustained in connection with or arising out of my Child’s participation in the Activities, including any and all actions taken by the Released Parties pursuant to this Waiver & Release Agreement. I voluntarily assume full responsibility for any risk of loss or property damage that may be sustained by my Child or any loss or damage to property owned by me or my Child as a result of my Child’s participation in the Activities. By my signature below, I understand and acknowledge that my Child’s participation in the Activities may involve risk of minor or serious injury, including due to transmission of communicable disease or illness and physical contact with other participants in the Activities, such as concussion or other head injury, permanent disability, death, and/or economic losses that may result from my Child’s actions or inactions, the actions or inactions of others, including other participants in the Activities, and the inherent risks of the Activities. I further understand and acknowledge that the Activities may involve risks related to travel by various means of transportation and outdoor activities, including but not limited to exposure to sun, heat, and other elements, and changing environmental conditions due to inclement weather, lightning, wind, or temperature. I fully understand, appreciate, and hereby assume all such known and unknown dangers and risks related to my Child’s participation in the Activities, including any and all actions taken by the Released Parties pursuant to this Waiver & Release Agreement, as well as transportation to and from the Activities, and athletic participation generally on behalf of my Child, and I voluntarily elect to allow my Child to participate in the Activities. I understand and acknowledge that my Child’s participation in the Activities may require a certain level of fitness for safe participation, especially due to the strenuous nature of athletic participation, and the “Parish” and the Archdiocese of Baltimore does not screen, medically or otherwise, individuals that participate in the Activities. I acknowledge that it is my sole responsibility to make certain that my Child is physically fit and healthy enough to participate in the Activities. In allowing my Child to participate in the Activities, I understand and agree that all policies and rules of the “Parish” and the Archdiocese of Baltimore apply to my Child and me during the Activities and that I will ensure that my Child and I comply with all such policies and rules. Further, I understand and agree that my Child and I are representatives of the “Parish” and the Archdiocese of Baltimore throughout the duration of the Activities and must exercise proper behavior and conduct as such. I understand and agree that the “Parish” reserves the right to exclude any participant from the Activities for failure to comply with such policies and rules or otherwise exhibiting inappropriate conduct as determined by the “Parish” or the Archdiocese of Baltimore in its sole discretion. I acknowledge and agree that I am responsible for paying for any and all damages to the facilities or equipment of the “Parish” and the Archdiocese caused by any negligent, reckless, or willful actions on my Child’s or my part. In the case of a health emergency or need of urgent healthcare, after a reasonable effort has been made to contact me and any named emergency contact(s) (or if the urgency of the circumstances does not allow for an attempt to contact me or any named emergency contact(s)), I authorize and consent to any medical care deemed necessary by the Released Parties for my Child’s health and safety during the Activities. When provided by the “Parish”, I hereby authorize the “Parish” and the Archdiocese of Baltimore to take photographs and video recordings of my Child in connection with my Child’s participation in the Activities. I acknowledge and agree that photographs or videos of participants in the Activities, including my Child, may be used and published for educational and promotional purposes, including, for example, such purposes as publications, website or social media content, or other print or electronic materials produced from time to time by the “Parish” and the Archdiocese of Baltimore. (Participants will not be identified by name, however, without specific written consent). I agree that if I do not wish my Child to be photographed or videotaped, I will notify Kristen Mumaw in writing. I understand that the “Parish” and the Archdiocese of Baltimore have no control over the use of photographs or videos taken of the Activities by media or others. If any provision or provisions of this Release Agreement are determined to be invalid or unenforceable, either in whole or in part, the parties agree that the invalid or unenforceable provision will be modified to the minimum extent necessary to render it valid and enforceable, so that the rights and obligations of the parties to this Release Agreement are preserved to the fullest extent permitted by law. I CERTIFY THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE ABOVE-NAMED CHILD, HAVE READ THE FOREGOING WAIVER & RELEASE AGREEMENT AND ANY ACCOMAPNYING ATTACHMENTS, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY, WILLINGLY, AND VOLUNTARILY. Signature Parent/Legal Guardian: (By entering my name below, I assert that I have reviewed and agree to all the waiver above) Type Electronic signature Below

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