VBS Registration
Monday, July 16 — Friday, July 20
9:30 a.m.—12:30 p.m.
For students entering First Grade through High School!
Event Address: New Grace Apostolic Temple, 2898 Packard Road Ann Arbor, MI 48108
Contact us at: (734) 477-6888 ext. 223
Due Date: July 1, 2018
Student Information
Please fill out one form per student
First Name Jayde *
Your answer
Last Name Degraffinriee *
Your answer
Address 3083 Velincia circle Ann Arbor 48108 *
Your answer
Days Attending
City *
Your answer
Zip Code *
Your answer
Age *
Your answer
Grade Completed 10 *
Your answer
Emergency Contact vickei *
Your answer
Relationship to Student mom *
Your answer
Emergency Contact Home Number 7347804747
Your answer
Emergency Contact Cell Number *
Your answer
Allergies/ Restrictions
Your answer
Students under 18 years old
Please fill out parent information for students under 18 years old
Name of Parent/ Guardian
Your answer
Daytime phone
Your answer
Person bringing student mom
Your answer
Person picking up student Floria grandma Jazmin sister
If a person, not listed below, will pick up the student, it is the parent's responsibility to call and alert New Grace Apostolic Temple.
Your answer
By submitting this form, I the parent have agreed that my child has my permission to attend Vacation Bible School at New Grace Apostolic Temple. I understand that all necessary care will be given to my child, and I will not hold New Grace Apostolic Temple liable, should an accident occur. *
How did you hear about this event?
Is Transportation Needed
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