Clone of Gateway Worship Centre Gravenhurst Junkyard Redemption 2025 Registration

Junkyard Redemption VBS REGISTRATION FORM 2026
CHILD INFORMATION:
Child Name

First NameLast Name
Birth Date

MonthDayYear
Child Name

First NameLast Name
Birth Date

MonthDayYear
Child Name

First NameLast Name
Birth Date

MonthDayYear
Child Name

First NameLast Name
Birth Date

MonthDayYear
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
EMERGENCY CONTACT INFORMATION
Emergency Contact Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Does your Child have any physical, emotional, mental, behavioral concerns or limitations that staff should be aware of? Yes or No. If yes, please explain and give instructions for staff.
Does your child have any allergies? Please include any special instructions.
I/we are aware that images of my child(ren) may be captured by staff of Gateway Worship Centre and placed on Facebook or Webpage. (We will always attempt to display images from behind so that no faces are shown). I/we are also aware that Gateway Worship Centre has no control over other participants taking pictures.
Parent/Guardian Signature:
Print Name Please:

First NameLast Name
Should be Empty:

Junkyard Redemption VBS REGISTRATION FORM 2026