2023 Madison VBS - Child Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dates: Monday July 10 through Friday July 14

Drop-Off Time: 8:50-8:55AM

Pick-Up Time: 11:50-55AM

Please complete this Registration Form once for each child who is attending.
Please do not put information for more than one child at a time. THANK YOU!

Student's Last Name *

Student's First Name *

Nickname or Preferred name of the Student

Mailing Address for the Student (Street, City, State, Zip) *

Date of Birth of the Student *

YYYY

Name (First and Last) of Parent/Guardian registering the Student *

Phone number of the Parent/Guardian *

E-Mail address of the Parent/Guardian *

Home Parish/Congregation of the Student

Grace Church (Episcopal)

Madison United Methodist Church

Presbyterian Church of Madison

Other:

Clear selection

Student's Last Grade of School Completed *

Pre K (3 or 4 year olds that are potty trained)

Kindergarden

1st

2nd

3rd

4th

5th

Emergency Contact 1 (Name and Cell Phone Number) [In case the Parent/Guardian listed above can not be reached] *

Emergency Contact 2 (Name and Cell Phone Number) [Optional]

Does the Student have any Allergies (food, etc) and/or other Medical Conditions that the VBS staff should be aware of.

Photo Release: By registering my child I understand that Grace Church (Episcopal) in Madison, NJ has permission to use my child’s photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *

Yes

Required

At least one parent/guardian per family is needed to help with 'set up' and/or 'clean up' of VBS decorations/room arrangement/etc [This will be approximately 2 hours - though shorter the more folks who we have to help]. Please indicate which you will be helping with: *

Set Up: Sunday, July 9 - 12 Noon (following Mass & Coffee Hour) until about 2:00PM

Clean Up: Friday, July 29 - 12 Noon (following VBS) until about 2:00PM

I will help at BOTH set up AND clean up (dates/times above)

Payment for registration can be made online at the Grace Church website, by mailing a check to the church office, or by placing a check in the offering basket/plate on Sundays. A donation to help cover the cost of supplies, etc is requested: $45 for 1 child, $80 for 2 children, $105 for 3+ children (per household). [NOTE: Scholarships are available if needed, please contact Father Asa for more info.] *

Online at www.gracemadison.org

By check (Please include "VBS registration" on the memo line)

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Grace Episcopal Church. Report Abuse

Forms