Proof Pirates VBS Registration
This form will be used to gather information about new registrants for our vacation bible school program
Join us at Grace Life Church of Lake City, FL
Email Address:
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Parent/Guardian's Name (Last, First)
Your answer
Please list all adults permitted to pick up children:
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Contact Phone Number
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Street Address
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City, State, Zip Code
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City, State, Zip Code
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Names, Birth dates and Ages of Children
Type your child's name and birth date under the grade he or she most recently completed.
Preschool
Your answer
Kindergarten
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Grade 1
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Grade 2
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Grade 3
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Grade 4
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Grade 5
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Allergies and Emergency Information - Picture Release
List any allergies (Type none if applicable)
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Emergency Contact Name
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Emergency Contact Phone
Your answer
Are we permitted to take pictures of your child?
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