CCGC VBS 2018 REGISTRATION FORM
“So faith comes from what is heard, and what is heard comes through the message about Christ.”
– Romans 10:17

Place: Contra Costa Gospel Church
2460 Buena Vista Ave. Walnut Creek

Date: Mon-Fri, June 11-15, 2018
Time: 9:00 am - 12:00 noon
Closing Ceremony & BBQ: Friday 12:15 pm
Parents and family are welcome. ($2 per person for BBQ)

For: Incoming Kindergarten (4-5 yrs old) – current 5th Graders

Fee:
Register by April 30, 2018 for discounted cost of
$80 per child, $75 for each additional child

Register by May 31, 2018 for cost of $100 per child
(Cash or Check payable to CCGC)

You can use this form to register for multiple children. Fill in the information below.

Please pick up VBS T-shirt on the first day of VBS!!! (**Full refund if cancelled by 4/30)

For registration questions, please contact: Stephanie Chang (ccgc.children@gmail.com)

***Photographs of the children will be taken for slideshows***

Child Name (First & Last Name) *
Your answer
Child Birthdate *
MM
/
DD
/
YYYY
Child Age *
Your answer
Child Current Grade In School *
Child T-Shirt Size *
Other siblings that you would like to register for? (Please list other children's names, DOB, age, current grade, tshirt size)
Your answer
#1 Parent/Guardian First & Last Name *
Your answer
#1 Parent Email Address *
Your answer
#1 Parent Phone Number *
Your answer
#2 Parent First & Last Name
Your answer
#2 Parent Email Address
Your answer
#2 Parent Phone Number
Your answer
Home Address *
Your answer
Does your family attend church? *
Would your family or friends like to attend the BBQ on Friday, June 15? ($2 per person) *
If yes, how many guests should we prepare for (including VBS registered kids)?
Your answer
Child's Medical Doctor Name: *
Your answer
Medical Doctor Phone Number *
Your answer
Child's Medical Insurance Policy & Number(s) *
Your answer
Other Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Child Allergy(s), Medical Condition(s), or Special Needs
Your answer
In an event that your child(s) is in need of emergency medical care, do you hereby grant permission to the staff of Contra Costa Gospel Church to secure emergency medical service and treatment for my child. *
Please put your first and last name and today's date as electronic signature of this form: *
Your answer
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