Grace Missionary Baptist Church
1301 Beacon Street
Springfield, Ohio 45505
917-717-9187

2019 VBS Registration

Child's Information
Child's Name:
Child's D.O.B. Child's Age: Last Completed Grade:
Food allergies:
Medical information we need to know:

Parent's Information
Parent/Guardian Name:
Address: City & Zip:
Home Phone: Cell Phone:
Email:

Emergency Contact
Name:
Relationship:
Phone:
Dismissal Authorization
Who is authorized to pick up your child?:
Do you attend Sunday School?
If yes, where?:
How did you hear about VBS?:

Picture Authorization
May we have permission to photograph your child?
May we have permission to use your child's photograph for the purpose of promotion?