VBS Registration

Parent/Guardian's Name (required)

Address

City, State ZIP

Phone Number

CellHomeWork

Email Address (required)

Child's Name (required)

Child's Gender (required)
MaleFemale

Child's Date of Birth (required)

Child's Last Grade Completed by Summer 2023 (required)
PreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade

Home Church Information

Medical Information (medications, allergies, etc.)

Emergency Contacts Other Than Listed Above

Who Else, If Anyone, May Pick Up Your Child After VBS Each Day?

May we have permission to photograph your child during the week for promotions (GRBC Instagram, Twitter, Facebook)?
YesNo

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