Stellar VBS 2023
Parent/ Guardian Information
Parent/ Guardian's Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In Case of Emergency
Use Parent/Guardian Information as In Case of Emergency contact
*
Yes
No
In Case of Emergency Contact
*
First Name
Last Name
In Case of Emergency Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Will anyone other than you be dropping off/ picking up your child(ren)?
Yes
No
Pickup Person
Pickup Person's Name
First Name
Last Name
Pickup Person's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Child Information
Child's Name
*
First Name
Last Name
Child's Birthday
*
-
Month
-
Day
Year
Date
Age Category
*
Please Select
Pre-k
Kindergarten
1+2 Grade
3+4 Grade
5+6 Grade
Choose grade level child just completed.
Child's Allergies
*
Type N/A if no allergies
Registering a Second Child?
*
Yes
No
Second Child
Child's Name
*
First Name
Last Name
Child's Birthday
*
-
Month
-
Day
Year
Date
Age Category
*
Please Select
Pre-k
Kindergarten
1+2 Grade
3+4 Grade
5+6 Grade
Choose grade level child just completed.
Child's Allergies
*
Type N/A if no allergies
Registering a Third Child?
*
Yes
No
Third Child
Child's Name
*
First Name
Last Name
Child's Birthday
*
-
Month
-
Day
Year
Date
Age Category
*
Please Select
Pre-k
Kindergarten
1+2 Grade
3+4 Grade
5+6 Grade
Choose grade level child just completed.
Child's Allergies
*
Type N/A if no allergies
Name of Home Church, if any:
*
Photography Agreement
I hereby grant permission to Grace EC Church to use photographs of my child(ren) on their Website and Facebook page for informational/ promotional purposes.
*
Agree
Disagree
Expectation Agreement
Please read the Child Behavior Expectation Policy and sign below.
Signature
*
Join our Facebook Group for photos & at home video lessons!
https://m.facebook.com/groups/3275766365993339/?ref=share&mibextid=S66gvF
Submit
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