Child's Name (required)

Child's Gender (required)
MF

Child's Age (required)

GradeLeaving

ShirtSize (required)

Address (required)

City (required)

Parent or Guardian Name (required)

Contact Phone 1 (required)

Contact Phone 2

Your Email

Allergies (required)

Medical Issues

Does your child have any special needs:

Emergency Contact Name (required)

Emergency Contact Number (required)

Alternative Pick-up 1

Alternative Pick-up 2

Does your child have a friend they would like to be placed with? If so, include the friends name:

I give permission for my child to be photographed or video recorded for any lawful purpose associated with this Vacation Bible School Function. (required)

I give my permission to the staff to seek medical attention for my child if necessary while participating in Vacation Bible School functions. I understand that all precautions will be taken for my child's safety. I will not hold Grace Free Will Baptist Church, the staff, or those supervising liable. Fill in your name below as your signature to give permission. (required)

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