VBS 2016 Registration

Registration Form
WHERE: Grace Church Haddonfield

19 Kings Highway East

Haddonfield, NJ 08033

CONTACT PERSON: Betsy Murphy, Director of Christian Formation

(856) 433-2151

gracehaddonfieldchurchschool@gmail.com

DATE: Monday, July 11 through Friday, July 15, 2016

TIME: 8:30 a.m. - 12:00 p.m.

WHO: Children age 4 by 1/1/2016 and up to having completed

the 5th grade. Must be fully toilet trained.

REGISTRATION: Registration is first come, first served up to 75 registrants

April 3, 1026 to June 5, 2016

COST: $25.00 per child

If you have any questions or financial concerns, please contact Betsy Murphy.
Child's Information
Child's Full Name*

First NameLast Name
FemaleMaleTransgender
Child's Date of Birth*

MonthDayYear
Child's Age
Grade last completed*
Child lives with
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Church (Name & Town)
Guardian 1 Name*

First NameLast Name
Guardian 1 Phone*
Guardian 1 Email*
Guardian 1 Address if different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Guardian 2 Name

First NameLast Name
Guardian 2 Phone*
Guardian 2 Email
Guardian 2 Address if different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Medical Information*
Emergency Contact*

First NameLast Name
Emergency Contact Phone*
Child's relation to emergency contacy
Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult Extra Large
The instruction and guidance given to the children by the VBS volunteers is an expression of love and commitment.

We realize that your time is a valuable gift and if there are areas in which you can help, please indicate:
Volunteer*
Emergency Medical Release*
Publication Release*
Full Name

First NameLast Name
Date

MonthDayYear
Signature

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After submitting your form. Please click here to make a secure payment or submit a payment to the Grace Church office.
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Registration Form

Child's Information