Grace United Methodist Church
Wednesday, May 24, 2017
 

Grace United Methodist Church  Vacation Bible School

2017 Registration Form

 
Please complete this form to register your child / children.  
Questions??  Email children@come-to-grace.org or call the Church at 724-330-5350.
 
 
 
 
General Information
 
Family Last Name:                Date: 
 
Child's Name:      Grade Entering in Fall 2017:      Birthday:     
Child's Name:      Grade Entering in Fall 2017:      Birthday:     
Child's Name:      Grade Entering in Fall 2017:      Birthday:      
Child's Name:      Grade Entering in Fall 2017:      Birthday:     
Child's Name:      Grade Entering in Fall 2017:      Birthday:      
 
 
Personal Information
Parent(s) / Guardian(s): 
Any other adults eligible for pickup: 
 
Address:
Home Phone:           Cell Phone:           Additional Cell Phone: 
 
E-mail address(es):
 
Allergies (Please be as specific as possible):
 
Additional information or requests:
 * Please note that due to grouping changes this year, we will ONLY accommodate ONE friend request per child. We will do our best to accommodate if BOTH children indicate the friend request on their form AND BOTH register by July 2.
 
PERMISSIONS
 
Media Permission:  I, , parent / guardian of  give permission for my child(ren) to be photographed, videotaped, and/or interviewed by representatives from the media or Grace United Methodist Church for the purpose of publicizing ministries or special events, including posting online.  I authorize the use and reproduction by Grace United Methodist Church or anyone authorized by Grace United Methodist Church of any and all photographs, video, or sound recordings taken of my child(ren) without compensation to me / my child.  All of these photographs, videos, or sound recordings shall be the property of Grace United Methodist Church.
Signed:           Date: 
 
In Case of Emergency: In the event of illness or accident, if I cannot be reached, I authorize the church or its agents to consent to diagnosis, examination, treatment, transport to medical center / hospital, or hospital care for my child which is deemed necessary by and is rendered under the supervision of a physician.  I release the church and its agents from responsibility in the case of an accident or illness in connection with any authorized church activities.
Signed:           Date: