St. Francis de Sales Church

Lebanon, Ohio

St. Francis de Sales Church is part of the Family of Parishes with St. Philip The Apostle Church in Morrow, OH

- VBS (Vacation Bible School)
  
  We are excited to announce VBS is back for St. Philip and St. Francis de Sales parishioners in grades K-5!!
  June 19th-23rd 9am-12pm
  
  STELLAR VBS is open to all kids entering grades K-5. Youth entering grades 6-12 are invited to be youth leaders.
  Adults are invited to consider being adult leaders for this fun and rewarding experience.
  Please contact PJ Ehling for more information at pehling@stfrancisdesales-lebanon.org
  
  Registration and other information will be available in the coming weeks.
- Pay Online Here
VBS Online Registration
- The maximum number of form submissions has been reached. This form is currently not available.
  
  The VBS at St. Francis de Sales is for participants in grades K-4. Grades 5-8 may sign up to volunteer. The VBS is located in the school building at 20 Desales Ave. Complete the online form below.
  
  Family Name REQUIRED Please fill out this field. Please enter valid data.
  
  Family ID - 4 Digits Maximum 9999 characters
  Found on Sunday envelopes or call parish office
  Please enter an integer (number) from 0 to 9999.
  
  Street 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.
  
  Mailing Address (if different) Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Primary Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Is it okay to share your Email with Parish Groups? Yes No
  
  Number of Parents/Guardians REQUIRED Please fill out this field.
  
  Parent/Guardian 1
  
  Relationship REQUIRED Please fill out this field.
  
  If Legal Guardian, Relationship to Child Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Cell phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Place of Employment REQUIRED Please fill out this field. Please enter valid data.
  
  Work 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.
  
  Interested in Volunteering? (requires compliance with Archdiocesan decree on child protection)
  
  If yes, what area? Please enter valid data.
  
  Parent/Guardian 2
  
  Relationship REQUIRED Please fill out this field.
  
  If Legal Guardian, Relationship to Child Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Cell phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Place of Employment REQUIRED Please fill out this field. Please enter valid data.
  
  Work 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.
  
  Interested in Volunteering? (requires compliance with Archdiocesan decree on child protection)
  
  If yes, what area? Please enter valid data.
  
  Archdiocese of Cincinnati - Permission, Release, and Authorization to Seek Medical Treatment
  1. I, the custodial parent/legal guardian of the above listed child(ren), give permission for my Child to participate in the activity described on the Activity Information Form (the “Activity”) and release from all liability, indemnify, and hold harmless St. Francis de Sales Parish and School, the Archdiocese of Cincinnati (the “Archdiocese”), the Archbishop of Cincinnati (the “Archbishop”), both individually and as trustee for the Archdiocese, all parishes and schools within the Archdiocese, and all of their agents, representatives, volunteers, and employees from any and all liability, claims, judgments, damages, costs and expenses, including attorneys’ fees, arising out of any injury, illness, infectious and/or communicable disease (such as MRSA, influenza, or COVID-19), or death, (including any injury, illness, infectious and/or communicable disease, or death caused by the negligence of Parish and School, the Archbishop, the Archdiocese, any parish or school within the Archdiocese, or any of their agents, representatives, volunteers, or employees) incurred by my Child while participating in the Activity, traveling to or from the Activity, or while using the facilities and equipment of the Parish and School. I further agree not to bring or prosecute or allow to be brought or prosecuted (including, but not limited to, prosecution through subrogation) in my name, or on behalf of my Child, any claims, lawsuits, or actions against Parish and School, the Archbishop, the Archdiocese, all parishes and schools within the Archdiocese, or their agents, representatives, volunteers, and employees.
  
  2. I understand that my Child’s participation in the Activity is purely voluntary and is a privilege and not a right, and that my Child, and I on behalf of my Child, agree to my Child’s participation in the Activity in spite of the risks of injury, illness, infectious and/or communicable disease (such as MRSA, influenza, or COVID-19), and death. I agree that if my Child has underlying heath concerns which may place him/her at greater risk of contracting COVID-19 or that would possibly increase the severity of illness if COVID-19 is contracted, then my Child and I will consult with a health care professional before participating in the Activity.
  
  3. I agree to instruct my Child to cooperate with the Archbishop or his agents in charge of the activity.
  
  4. I authorize the agents of Parish and School and/or the Archdiocese who are acting as leaders of the Activity to seek medical treatment for my Child in the event of any injury, illness, or medical emergency during the Activity or related travel. I understand that the agents of Parish and School and/or the Archdiocese will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my Child.
  
  5. The Parish and School and/or the Archdiocese may use my Child’s portrait or photograph for promotional purposes, website, and office functions. REQUIRED I agree I do not agree Please fill out this field.
  
  6. The Parish and School and/or the Archdiocese may use social media and technology to communicate with my Child regarding parish/school related ministry activities. REQUIRED I agree I do not agree Please fill out this field.
  
  7. This Permission, Release, and Authorization is intended to be as broad and inclusive as permitted by the law of the State of Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This Permission, Release, and Authorization shall be construed in accordance with the laws of the State of Ohio, excluding, and irrespective of, any choice of law principles to the contrary.
  
  8. Parish and School, the Archdiocese, the Archbishop and their agents, employees, and volunteers shall have no liability whatsoever in the event the Activity is cancelled due, in whole or in part, to any present or future pandemic, epidemic, widespread disease or illness, public health concern, or circumstances arising therefrom, or from actions taken by any governmental or municipal authority to prevent, avoid, or mitigate the impacts thereof.
  
  I have carefully read and understand and accept the terms and conditions stated herein and I acknowledge and agree that this Permission, Release, and Authorization to Seek Medical Treatment shall be effective and binding upon me, my Child, and our personal representatives, estates, assigns, heirs, and next of kin. I have signed below of my own free will.
  Yes, I have carefully read and understand and accept the terms and conditions. Please select this field.
  
  Signature of Custodial Parent / Legal Guardian: Please type your name here to confirm that you have fully read and agree to the above stated. Typing your name here will act as an electronic signature and will be sufficient. REQUIRED Please fill out this field. Please enter valid data.
  
  Medical Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medical Insurance Policy Number REQUIRED Please fill out this field. Please enter valid data.
  
  Policy Holder's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number (Home) REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number (Work) REQUIRED Please fill out this field. Please enter valid data.
  
  Family Doctor's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Family Doctor's Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Preferred Hospital REQUIRED Please fill out this field. Please enter valid data.
  
  Other Emergency Contact (if parent cannot be reached) REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Emergency Contact Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Any Custody Issues? Please enter valid data.
  
  Comments? Please enter valid data.
  
  Number of Children REQUIRED
  Number of children to be attending PSR classes
  Please fill out this field.
  
  Child 1
  
  First name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Kindergarten 1 2 3 4 5 6 7 8 Please fill out this field.
  
  Birth date REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions, Medications, Allergies, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED
  Please list N/A if this does not apply.
  Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Allergies REQUIRED Please fill out this field.
  
  Medical Conditions, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED Please fill out this field.
  
  Incoming Grade REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Maximum 10 characters Please fill out this field. Please enter valid data.
  
  Child 2
  
  First name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Kindergarten 1 2 3 4 5 6 7 8 Please fill out this field.
  
  Birth date REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions, Medications, Allergies, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED
  Please list N/A if this does not apply.
  Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Allergies REQUIRED Please fill out this field.
  
  Medical Conditions, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED Please fill out this field.
  
  Incoming Grade REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Maximum 10 characters Please fill out this field. Please enter valid data.
  
  Child 3
  
  First name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Kindergarten 1 2 3 4 5 6 7 8 Please fill out this field.
  
  Birth date REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions, Medications, Allergies, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED
  Please list N/A if this does not apply.
  Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Allergies REQUIRED Please fill out this field.
  
  Medical Conditions, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED Please fill out this field.
  
  Incoming Grade REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Maximum 10 characters Please fill out this field. Please enter valid data.
  
  Child 4
  
  First name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Kindergarten 1 2 3 4 5 6 7 8 Please fill out this field.
  
  Birth date REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions, Medications, Allergies, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED
  Please list N/A if this does not apply.
  Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Allergies REQUIRED Please fill out this field.
  
  Medical Conditions, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED Please fill out this field.
  
  Incoming Grade REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Maximum 10 characters Please fill out this field. Please enter valid data.
  
  Child 5
  
  First name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Kindergarten 1 2 3 4 5 6 7 8 Please fill out this field.
  
  Birth date REQUIRED Please fill out this field. Please enter a date.
  
  Medical Conditions, Medications, Allergies, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED
  Please list N/A if this does not apply.
  Please fill out this field. Please enter valid data.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name (if different) Please enter valid data.
  
  Allergies REQUIRED Please fill out this field.
  
  Medical Conditions, Chronic Conditions (i.e. Epilepsy, Diabetes) REQUIRED Please fill out this field.
  
  Incoming Grade REQUIRED Please fill out this field.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Birth Date REQUIRED Maximum 10 characters Please fill out this field. Please enter valid data.
  
  2022 VBS Fees - Please Choose Your Method of Payment REQUIRED Please fill out this field.
  
  Activity Information
  
  Program: VBS
  
  Location: St. Francis de Sales School - 20 Desales Ave. Lebanon, OH 45036
  
  Starting Date: June 20, 2022
  
  Ending Date: June 24. 2022
  
  Starting Time: 9am
  
  Ending Time: 12pm
  
  Registration Fee: $20 per child
  
  Program Leader: Anslie DeFalco
  Email: stfrancisdesalesvbs@gmail.com
  
  Signature of Custodial Parent/Guardian: By typing your name here you are electronically signing this form. REQUIRED Please fill out this field. Please enter valid data.
  
  Submit
  
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- Contact Us
  
  Anslie DeFalco
  Contact for Volunteering
  stfrancisdesalesvbs@gmail.com
  
  P.J. Ehling
  
  Director of Faith Formation
  
  513-932-2601 ext. 203
  pehlingstphilipmorrow.org

Archdiocese of Cincinnati - Permission, Release, and Authorization to Seek Medical Treatment

Activity Information