Holy Family Catholic Parishes

VBS Registration

VBS Registration

Contact Us

Last Name:

Mother's Name

Cell Phone:

Father's Name

Cell Phone

Street Address

City

State

Zip

E-Mail Address

Home Parish

Permission to publish pictures which may include your child's image

Yes

No

Child's Name

Last School Grade Completed

Child's Gender

Date of Birth

Child's Name

Last School Grade Completed

Child's Gender

Date of Birth

Child's Name

Last School Grade Completed

Child's Gender

Date of Birth

Child's Name

Last School Grade Completed

Child's Gender

Date of Birth

Food Allergies, Medical Conditions, Special Needs (include Child's name if more than one child)

Emergency Contact Name

Emergency Contact Phone

Relationship to Child:

Payment Method

Mail Check

Put in Offertory in Envelope w/Child's Name

Stop by the Office

Holy Family Parish

Contact Us

fortmadholyfamily@diodav.org

1013 Avenue E
Fort Madison, IA 52627

Office Hours

Monday - Thursday:

8:30 am - 4:00 pm

Friday

8:30 am - noon

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