VBS Registration

 

Sunday, June 11 - Thursday, June 15

Family Dinner at 5:30pm and VBX from 6:00 - 8:30pm. 

Exploring the Coolest Book on the Planet!

Please fill out this form to register your children today. If you need to register additional children, or need to register students who are not your own, please enter multiple submissions.

You will need to sign a release form the first night of VBX

Child's Name
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Date of Birth (month/day/year)
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Age
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Gender
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Grade Completed
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Address
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Parent/Guardian's Name
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Parent's Contact Phone Number --
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Parent's Email
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Emergency Contact Name
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Emergency Contact's Relationship To Child
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Emergency Phone Number --
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Please Place My Child With
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How Did You Hear About VBX?
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Are You Involved in a Local Church?
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Photography Permission
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I authorize Grace Bible Church to use and reproduce any photos, narratives, interviews, audio and video of my child's participation for any or all purposes. Child's name will not be used in conjunction with any materials.
Medical Information
Emergency Medical Care and/or Transport
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I give Grace Bible Church permission to have my child transported to (Hospital/Clinic) for emergency medical care, or to the nearest available source of assistance.
Name of Hospital or Clinic allowed to use:
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Allergies (food,medication or environmental) and precautions, reactions, treatments:
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Medications, food supplements, modified diet currently being administered:
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Chronic physical problems:
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Any additional health or enrollment information we should know about your child:
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For security purposes, please enter the text that appears in the box below.
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