VCS Registration - The Three Day Pascha

Vacation Church School

June 11th - 14th, 2023

6:00 PM - 8:00 PM (Sunday 12:00 PM - 3:00 PM @ Richmond Park: 963 Richmond St. NW Grand Rapids, MI 49504)

Hosted at St. Nicholas Antiochian Orthodox Christian Church (2250 E. Paris Ave. SE Grand Rapids, MI 49546)

Parent/Guardian's Name

*

Phone

*

Email

*

This address will receive a confirmation email

Address

*

Additional Parent/Guardian First and Last Name

Phone

Email

Home Parish/Church

*

Please select one option.

Holy Cross Holy Trinity St. George St. Nicholas St. Wilibrord Other

Student Information Section

Student (1): First Name

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Student (1) Last Name

*

Student's Date of Birth [MM], [DD], [20YY]

*

Grade of Student in FALL 2023

*

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Student Allergies/Dietary Restrictions/Medical Needs if Any (Snacks are Provided Each Night)

*

Please Note Anything Else That We Should Know About Your Youth That Will Help Him/Her Succeed In Our Program: Learning/Behavioral/Social Concerns (Write N/A For Not Applicable)

*

Student (2): First Name

Student (2) Last Name

Student's Date of Birth [MM], [DD], [20YY]

Grade of Student in FALL 2023

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Student Allergies/Dietary Restrictions/Medical Needs if Any (Snacks are Provided Each Night)

Please Note Anything Else That We Should Know About Your Youth That Will Help Him/Her Succeed In Our Program: Learning/Behavioral/Social Concerns (Write N/A For Not Applicable)

Student (3): First Name

Student (3) Last Name

Student's Date of Birth [MM], [DD], [20YY]

Grade of Student in FALL 2023

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Student Allergies/Dietary Restrictions/Medical Needs if Any (Snacks are Provided Each Night)

Please Note Anything Else That We Should Know About Your Youth That Will Help Him/Her Succeed In Our Program: Learning/Behavioral/Social Concerns (Write N/A For Not Applicable)

Student (4): First Name

Student (4) Last Name

Student's Date of Birth [MM], [DD], [20YY]

Grade of Student in FALL 2023

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Student Allergies/Dietary Restrictions/Medical Needs if Any (Snacks are Provided Each Night)

Please Note Anything Else That We Should Know About Your Youth That Will Help Him/Her Succeed In Our Program: Learning/Behavioral/Social Concerns (Write N/A For Not Applicable)

Student (5): First Name

Student (5) Last Name

Student's Date of Birth [MM], [DD], [20YY]

Grade of Student in FALL 2023

Please select one option.

Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Student Allergies/Dietary Restrictions/Medical Needs if Any (Snacks are Provided Each Night)

Please Note Anything Else That We Should Know About Your Youth That Will Help Him/Her Succeed In Our Program: Learning/Behavioral/Social Concerns (Write N/A For Not Applicable)

Payment

$10/Child Maximum of $30/Family If You Need a Scholarship, Please See Your Priest.

Payment

1 Child ($10) 2 Children ($20) Family Rate (3 or more children) ($30)

Amount

Scholarship Assistance

If You are Interested in Financially Supporting Other Children so That They can Attend Summer Orthodox Church Camp, Please Enter Your Donation Amount Below:

Payment $

Credit Card Information

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Vacation Church School

June 11th - 14th, 2023

6:00 PM - 8:00 PM (Sunday 12:00 PM - 3:00 PM @ Richmond Park: 963 Richmond St. NW Grand Rapids, MI 49504)

Hosted at St. Nicholas Antiochian Orthodox Christian Church (2250 E. Paris Ave. SE Grand Rapids, MI 49546)

Please Fix the Following

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