VBS 2024 Registration | PreK, Kinder, + 1st Grade

Please fill out one form per child, being mindful of the approriate age group. Questions? Email Pastor Camille: camille@glendoranaz.org

Parent/Guardian Information

Parent/Guardian Name

This address will receive a confirmation email

Phone

Address

Payment $15.00

Child Information (Preschool/4 Years - 1st Grade)

Child's Name

Child's Grade for Upcoming School Year

Preschool (4 Years + Potty-trained) Kindergarten 1st Grade

Child's T-Shirt Size

Youth Small Youth Medium Youth Large Youth X-Large

Emergency Info + Pickup

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Child:

Names of other adults approved to pick-up child from VBS:

Child's Medical Information

Name of Primary Care Physician:

Medical Insurance Group

Insurance Policy No. or Name of Policy Holder

Child's Allergies or Medical Conditions:

GCC VBS Photo + Medical Release

Photo Release: By registering your child for VBS, please understand that your child may appear in photos that could be used on our website, social media, or printed material. No personal information about your child will appear in those photos.

Medical Release: In the event of a Medical Emergency, every effort will be made to notify the parent/guardian or the stated Emergency Contact Person. If the parent/guardian or Emergency Contact Person cannot be reached, Glendora Community Church has permission to notify a medical professional and to authorize recommended treatment for the medical emergency.

Response to Photo Release:

I consent to the Photo Release and understand my child may be photographed. I do not consent to the Photo Release form--please do not photograph my child.

Initial here to consent to Medical Release:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Thanks for registering for VBS 2024! We're excited for a week of fun with each child. Please remember that VBS begins at 9:00am and ends promptly at 12:30pm. Drop-off begins at 8:45am. You must present your security tag (or a photo of your security tag) at Pick-Up!

Questions? Email Pastor Camille: camille@glendoranaz.org

VBS 2024 Registration | PreK, Kinder, + 1st Grade

Description

Please Fix the Following