Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

Media Release

I, as the Parent/Legal Guardian, hereby grant permission to Grace Community Church, its agents and assigns, to use above named child’s photo or video, and likeness for the purpose of promotion by Grace Community Church for all forms, media and manners, for the following, but not limited to, news releases, photographs, video, audio, website, marketing, advertising, trade, promotion, exhibition for an indefinite period of time.

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