GCBC VBS Registration
Child Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Last Grade Completed *
Parent/Guardian Name *
Your answer
Parent Phone Number *
Your answer
Parent Email Address *
Your answer
Home Address *
Your answer
Emergency Contact Name
(If different from parent/guardian)
Your answer
Emergency contact Phone number *
Your answer
Food Allergies *
Your answer
Medical Concerns *
Your answer
Names of other siblings attending *
Your answer
GCBC Affiliation *
Required
Church Membership at? *
Your answer
People who may pick up child *
Your answer
Submit
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