Grace Vacation Bible School Registration Form
Monday, June 24th-Friday, June 28th from 9 am - 12 pm
for rising Kindergarten through 5th grade students
Contact: Rev. Nanette+  |  associate@GraceChurchYorktown.org  |  757.898.3261
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Email *
What is your name and relationship to the child(ren)? *
What is your email address?  *
What is your address? *
What are the names and ages of your children attending VBS? *
What is your best phone contact? *
Who is your emergency contact person, what is their relationship to you, and what is their number? *
What is your primary physician's name and phone number? *
What is your dentist's name and phone number? *
Does your child(ren) take any medication? If so, write the name, the dose, the treatment it is for, and dispensing instructions. *
What, if any, food allergies do your children have? *
What are the names and numbers of the adults who may pick up your child? *
Every Parent (at least one) is expected, if available, to volunteer as a Shepherd each day.  The Shepherd will accompany a group of children to the various activities, and help serve snack (we will provide the snack). You may be a Shepherd more than one day if you wish! Please indicate what day(s) you would like to volunteer (Mon., Tues., Wed., Thurs. or Fri.); or please simply say that you are unable to volunteer.  *
Please explain any medical conditions  your child may have. *
Please explain any pertinent information (behavioral or emotional or physical) about your child that would be important for the adult leaders to know. *
Please tell us the name of your Medical Insurance Company, Policy/Group ID# and Policy Holder's Name *
There is no cost to this program, however, children will be given "water bottle banks" to collect change in for daily offerings towards a gift to the Episcopal Relief and Development Fund (ERD), like a goat for a family, or a water system for a community!
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