VBS Registration

2016 Vacation Bible School Registration

Registration for 2017 will take place on another page. This was only for 2016.

Child's Name *

First

Last

Name Child Goes By (for Name Tag) *

Parent/Gardian's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Home Church *

Allergies and/or Dietary Restrictions *

Other Important Health Information *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Relationship to Child *

Waiver
I authorize that Grace Presbyterian Church and it's delegated leaders can consent to any medical/hospital care deemed necessary in the case of an emergency. I consent to the release of this health history to the emergency room, hospital, or doctor's office providing care. I release Grace Presbyterian Church and its designated leaders from any liability or claims arising from any consent given in good faith in connection with diagnosis or treatment.

When paying for VBS, please type your child(ren)'s name in the "NOTES TO SELLER" place.

I have read the waiver. *

Agree

Submit