Grace Evangelical Free Church

VBS Online Registration Form
Sunday, July 11- Thursday, July 15, 2010
6:00pm - 8:30pm

For ages 4 years (by July 11, 2010) through 
children entering 5th grade in Fall 2010.

Please fill out completely before submitting online. One form per child.
CHILD INFORMATION - Please fill out one form per child
Child Information:
Child's Name Age Grade your child will enter in Fall 2010
 
Birthday: example:  3/7/05
Address:
City:   State:  Zip:
Home Church:
EMERGENCY  CONTACT INFORMATION
Contact Name
Home Phone
Cell Phone
Any Allergies and/or Medical Problems we should be aware of:
 Please be specific about special needs or dietary restrictions

My child has my permission to attend VBS sponsored by Grace Evangelical Free Church. I will not hold Grace Church responsible for any injuries the above named child may incur while participating in VBS activities. As a parent (or guardian), I do hereby authorize treatment by a qualified and licensed medical doctor of the above named minor in case of a medical emergency that may, in the opinion of the attending physician, endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me.

This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment, under emergency circumstances, in my absence. The effective date of this release is July 11 - 15, 2010.

  Date

Parent/Guardian: 

Digital Signature of Parent or Guardian (enter your initials):

(Permission is indicated by the name appearing on the above lines)

Ready to submit your child's registration? 

Please Click the button and WAIT for the page to show your registration has been successfully generated.  If you do not see a confirmation page, please call Rod Brunson or Kerry Moodey at the church office (303)772-5685 to confirm receipt of the registration information
CLICK to transmit your information
to Grace Evangelical Free Church