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VBS Registration
Please complete a form for each child that will be attending VBS at Grace Baptist Church. Feel free to contact the church with any questions by calling (812) 254-3459.
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* Indicates required question
Child's Name
*
Your answer
Birth date
*
MM
/
DD
/
YYYY
Grade Completed (or age if not in school)
*
Choose
Age 4
Age 5
PreK/Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zipcode
*
Your answer
Parents/Guardian Name
*
Your answer
Contact Phone Number
*
Your answer
E-mail
Your answer
Emergency Contact (please list name, relationship to the child, and contact number if different from above)
*
Your answer
Name of Home Church if other than Grace Baptist
Your answer
Food Allergies
*
Yes
No
If there are food allergies, what are they and what is the reaction?
Your answer
Medical Concerns (please list anything you feel would be important)
Your answer
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