2019 VBS Registration
2019 VBS Registration
If any of your children has special needs (IEP, autism, ADHD etc) or allergies, please contact carrieyeaman@gcchome.org BEFORE you register.
We want to be able to plan to support your child in the best way to allow them to have a successful VBS.
Parent/Guardian Name:  * 
Street Address:  * 
City  * 
Zip  * 
House Phone:
Cell Phone:  * 
Your Email Address  * 
Emergency Contact Name:  * 
Emergency Contact Phone #:  * 
Authorized Person for Pickup #1 (Full Name):
Authorized Person for Pickup #2 (Full Name):
Name of your home church. If none please write "None"  * 
Please input information about each child in your family who will attend. Child must be age 4 before 6/1/2019 along with some classroom experience.
CHILD 1 Full Name:  * 
CHILD 1 Date of Birth (MM/DD/YY):  * 
CHILD 1 Sex:  * 
CHILD 1 Incoming Grade for Fall 2019  * 
CHILD 1 T-Shirt Size:  * 
CHILD 1 Allergies/Special Needs:
CHILD 2 Full Name:
CHILD 2 Date of Birth (MM/DD/YY):
CHILD 2 Sex:
CHILD 2 Incoming grade for fall 2019
CHILD 2 T-Shirt Size:
CHILD 2 Allergies/Special Needs:
CHILD 3 Full Name:
CHILD 3 Date of Birth (MM/DD/YY):
CHILD 3 Sex:
CHILD 3 Incoming Grade for Fall 2019
CHILD 3 T-Shirt Size:
CHILD 3 Allergies/Special Needs:
Use this box to add any other relevant information and/or to give information on more children.
The next section is for payment information. The cost per child is $10 (maximum $30 per family). If you need a scholarship, please contact carrieyeaman@gcchome.org.
Please input the total amount to be paid:  * $ 
Total $
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