5 Day Club Registration

Grace Church-South Campus 3099 County Road 5 Barnum, MN 218-879-5749 July 21st-July 25th, 6:00 pm to 7:30 pm

VBS is available for children 3 years old to 12 years old. Must be potty trained.
How many children are you registering?*
Child Information
First Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Gender
Last Grade Completed*
Does the child attend Sunday school anywhere?*

YesNo
Where?
Medical or other information we may need to know about the child (including food allergies, gluten free).*
Second Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Gender
Last Grade Completed*
Does the child attend Sunday school anywhere?*

YesNo
Where?
Medical or other information we may need to know about the child (including food allergies, gluten free).*
Third Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Gender
Last Grade Completed*
Does the child attend Sunday school anywhere?*

YesNo
Where?
Medical or other information we may need to know about the child (including food allergies, gluten free).*
Fourth Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Gender
Last Grade Completed*
Does the child attend Sunday school anywhere?*

YesNo
Where?
Medical or other information we may need to know about the child (including food allergies, gluten free).*
Child Release Information
Parent/Legal Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names of Persons to which the child (children) may be released to each night after 5 Day Club(Please provide at least two)*

First NameLast Name
Full Name*

First NameLast Name
Full Name

First NameLast Name
Full Name

First NameLast Name
Are there any persons to which the child (children) may NOT be released to?*

YesNo
Who may you child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 2 Phone Number*

Area CodePhone Number
Photography Consent
I understand my child(ren) whose names are listed above may be photgraphed during VBS. I understand that these photographs may be used in the end of the 5 day wrap-up video and may be on Grace Church's Facebook page or website. I give permission for my child(ren) to be photographed for the end of 5 Day wrap-up and on Grace Church's Facebook page or website.

I AgreeI Disagree
Should be Empty:

Grace Church-South Campus 3099 County Road 5 Barnum, MN 218-879-5749 July 21st-July 25th, 6:00 pm to 7:30 pm

Child Information

First Child

Second Child

Third Child

Fourth Child

Child Release Information

Photography Consent