Vacation Bible School

Student(s) Information

If you need to register more than 3 participants, please fill out the form again.

Participant #1

Name of Participant #1

Birth Date

Grade (2019-2020 School Year)

Does this child have any allergies or medical needs of which we should be aware? If yes, please explain.

Participant #2

Name of Participant #2

Birth Date

Grade (2019-2020 School Year)

Does this child have any allergies or medical needs of which we should be aware? If yes, please explain.

Participant #3

Name of Participant #3

Birth Date

Grade (2019-2020 School Year)

Does this child have any allergies or medical needs of which we should be aware? If yes, please explain.

Parent / Guardian

Name of Parent or Guardian

Address

City

State

Zip Code

Daytime Phone

Evening Phone

Email

Emergency Contact

Emergency Contact Phone

I certify that I am the parent/guardian of the child listed on this form. By submitting this form I agree to the following terms and conditions.

Terms and Conditions

I give permission for these children to attend VBS 2019 at Grace Community Church at 1290 Minesite Rd. Allentown, Pa. 18103

I understand that all reasonable safety precautions will be taken at all times by
Grace Community Church and its agents during the events and activities. I authorize treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of emergency. I understand the possibility of unforseen hazards and know the inherent possibility of risk.

I agree not to hold Grace Community Church, its leaders, employees, or volunteer staff liable for damages, losses, diseases, or injuries incurred by the child named on this form.

Photography Permission

Does Grace Community Church have permission to video or photograph these children and use in church promotions and website?

GCC has permission to photography these childrenGCC DOES NOT have permission to photography these children

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