2024 VBS (Breaker Rock Beach) Registration

Child Information

Child's Name

Birthdate

Gender

Male Female

Grade

Grade - List Grade Just Completed

Current Church Attending

Allergies/Medical Conditions

For allergies/medical conditions type 'N/A' or 'None' if not applicable.

Parent Information

Parent's Name

This address will receive a confirmation email

Phone Number

Address

Preferred Contact Methods

Text Email None

Additional Parent/Guardian (if you can't be reached)

Additional Parent/Guardian Phone Number (if you can't be reached)

Emergency Medical Release

In the event of an emergency where medical treatment is required, I give my permission to the VBS leaders or church staff to obtain the services of a licensed physician. Please attempt to notify me immediately concerning any such emergency. I assume all financial responsibility for any expenses incurred.

I hereby acknowledge that Grace Community Church, its staff, or VBS leaders cannot be held responsible for any injury to my son/daughter.

Typing your name below is an acknowledgement of the above statement.

Parent Name to Acknowledge

Date of Acknowledgement

Photo Permission

Do we have your permission to use photos of your child from this event for public use?

Yes No

2024 VBS (Breaker Rock Beach) Registration

Description

Please Fix the Following