Grace Evangelical Free Church

VBS Online Registration Form
July 13-17, 2009
6:00pm - 8:30pm

Please fill out completely before submitting online. One form per child.
CHILD INFORMATION - Please fill out one form per child
VBS is for children 3 years old through 5th grade (entering 6th grade in fall)
Child Information:
Child's Name Age Grade Completed by Spring 2009
 
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:

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 13 - 17, 2009.

  Date

Parent/Guardian: 

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

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

Click to transmit your information
to Grace Evangelical Free Church