Gurnee Community Church

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:	* $
FOR OFFICE USE ONLY: CASH/CHECK + AMOUNT

Total	$