G-ForceVBS Registration (Child+Adult)
Monday, July 22 - Thursday, July 25
5:30 - 7:30 pm
*Meal provided each night from 5:30 - 6:00 pm for participants and volunteers.

Location:
Emanuel UCC
304 East Adams St.
Jackson, MO 63755

Contact:
Jessica @ 450-7257

Theme Verse: In God we live, move, and exist. Acts 17:28a
G-Force VBS Registration (Child/Adult)
Student's Name *
Your answer
Parent/Guardian Name (Mark "NA" if Adult Student) *
Your answer
I am . . . (select ALL THAT APPLY) *
Required
Address
Your answer
E-mail Address
Your answer
Phone *
Your answer
Student's Age *
Last School Grade Completed *
Home Church
Your answer
Allergies/Medical Information/Other *
Type "NA" if no concerns.
Your answer
Emergency Contact 1 *
Type Name and Number
Your answer
Emergency Contact 2 *
Type Name and Number
Your answer
Name(s) of person(s) who may pick up this child from VBS: *
Mark "NA" if Adult
Your answer
Submit
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