Monday, December 10 - Thursday, December 13, 2018: 5:00 pm - 7:00 pm 

   Please list any days your child/children will NOT be attending:

  Completing this registration states that I have agreed to indemnify and hold harmless Grace United Methodist Church, its employees, directors, officers, volunteers, or agents for any injury, expenses or fees sustained related to the above referenced activity. I also give permission to Grace United Methodist Church to use photographs and/or video from this event to use for promotional purposes for its Website, brochures, etc.    

  By typing my name below, I acknowledge that the above information is correct, and that     I agree to these terms via electronic signature.  This completed form signifies that I provide consent and that I am the authorized person to act on behalf of the child.

Type Your Full Name Here:  

Today's Date:
1 Child's Full Name:
1 Child's Age:
D-O-B (mm/dd/yyyy):
1 Child's Gender:
Parent 1 Full Name:
City, State, Zip Code:
Home Phone:
Cell Phone:
Email Address:
Home Congregation:

In case of emergency when parent/guardian cannot be reached?
Relationship to Child:
Please list any allergies/medical needs that VBS Staff should be aware of: 

Person responsible for picking up child/children at the end of VBS each day:
Adult's Full Name 
for child 1:
Phone 1:
Adult's Full Name for child 2:
Phone 2:
2 Child's Full Name:
2 Child's Age:
D-O-B (mm/dd/yyyy):
2 Child's Gender:
Parent 2 Full Name:

Parent Information
2 Child's Grade:
1 Child's Grade:
Please list any allergies/medical needs that VBS Staff should be aware of: