VBS Registration

Parent/Guardian's Name (required)

Address

Home Number

Cell Number

Work Number

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 2019 (required)
NurseryPreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade

Home Church Information

Medical Information (medications, allergies, etc.)

Emergency Contacts Other Than Listed Above

Who 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

Please register my child for Wacky Water Wednesday as well
Yes

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