Vacation Bible School Shipwrecked Registration Form (1 Per Child)
Vacation Bible School Shipwrecked Details!
PLEASE READ FIRST!!

PLEASE NOTE: We currently have a WAIT LIST for all new registrants as we try to get more volunteers to cover more kids in the program.

DATE: June 18-22, 2018 9am-12:30pm
LOCATION: Ponderosa Elementary School (804 Ponderosa Ave, Sunnyvale)
COST
Regular Rate (Registration ENDS May 20):
$60 per child
$10 per Nursery (Baby and Me child)
QUESTIONS: Please contact us at kidzone@grx.org or 408-988-0222

Please NOTE: Submission of this Registration Form is not a guarantee that your child(ren) are in the program. You will receive an email shortly letting you know if:
a) Your Child is on a wait list
b) Your Child is in the program

If your child is in the program, you will receive payment information at that time.

If you do not receive an email within a week, please email kidzone@grx.org to check on your status

GENERAL INFORMATION
Parent/Guardian's First Name *
Your answer
Parent/Guardian's Last Name *
Your answer
ADDRESS INFORMATION
PLEASE FILL OUT ADDRESS INFO ONLY IF THIS REGISTRATION IS FOR YOUR FIRST CHILD

***ADDRESS INFO NOT REQUIRED IF THIS IS FOR 2ND+ CHILD

Home Address
Your answer
City
Your answer
Zip
Your answer
CONTACT INFORMATION
Home Phone # *
Your answer
Alternate Phone #
Your answer
Email Address *
Your answer
Does Your Family Currently Attend a Church? *
Required
If so, which church?
Your answer
How did you hear about our program/did someone invite you? If so, who?
Your answer
EMERGENCY CONTACT INFO
PLEASE FILL OUT EMERGENCY CONTACT INFO ONLY IF THIS IS THE FIRST CHILD YOU ARE REGISTERING

***EMERGENCY CONTACT INFO NOT REQUIRED IF THIS IS FOR 2ND+ CHILD REGISTERING

Emergency Contact Name
Your answer
Relationship to Child
Your answer
Emergency Phone Number
Your answer
ALTERNATE PICK UP INFORMATION
Please fill out if you plan to have someone else pick up your child during the week. (i.e. spouse/guardian, grandparent, sibling) Please NOTE that we CAN NOT release child to anyone who is not listed below or parent listed above.
Alternate Pick Up #1
Your answer
Relationship to Child
Your answer
Alternate Pick Up #2
Your answer
Relationship to Child
Your answer
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