Twice Loved VBS Registration Form Please Fill Out One Form Per Child
When: July 8 - 11, 2019 from 6:15 to 7:45 pm
Event Address: 360 Hopkins Rd. Kernersville, NC 27284
Contact us at
Email address *
Parents' Names *
Your answer
Child's Name *
Your answer
Address *
Your answer
Your Contact Number During VBS *
Your answer
Child's Date of Birth *
Your answer
Completed Grade for 2018-2019 School Year *
Your answer
Siblings at VBS and Ages *
Your answer
Allegies/Medical Conditions *
Your answer
What days will your child attend? *
Meal Reservations (Optional)
Cost $9 per person for the entire week
Meal reservations must be made prior to Wednesday, July 3
Parents will need to supervise their children during the meal
Peanut Free Menu
The meals for the week are as follows:
Monday—Chicken Patties/Nuggets Wednesday—Pizza
Tuesday—Spaghetti Thursday—Hot Dogs
Family Name
Your answer
Number Eating
Your answer
Total ($9 per person)
Your answer
Specific Activity Permissions, Waiver, and Indemnification Form
I hereby represent that I am the parent/legal guardian of___________________________________________________, who is under 18 years of age. I give permission for my child to participate in the following activities of Grace Presbyterian Church:all VBS activities I acknowledge that there are certain risks associated with such activities, both known and unknown, including but not limited to risk of physical injury due to activity and transportation related accident, illness, or even death, and I hereby agree to release, hold harmless, indemnify any claim that my child, family, or I may have against them arising out of or related in any way to my child’s participation in this activity. This shall include without limitations, any claims of negligence, or breach of warranty. I also hereby agree to be bound by all of the terms and conditions of the Grace Presbyterian Church Permission, Waiver, and Indemnification Form signed by me and/or my spouse at an earlier date and herby represent that all of the information provided in this form continues to be accurate.
Signature of Parent or Legal Guardian _______________________________________________ Date: _____/_____/______ *
Your answer
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