2023 Grace Church VBS - Child Registration Form
Dates: Monday July 10 through Friday July 14    
Drop-Off Time: 8:50-8:55AM     
Pick-Up Time: 11:50-55AM

Please complete this Registration Form once for each child who is attending.
Please do not put information for more than one child at a time. THANK YOU!
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Student's Last Name *
Student's First Name *
Nickname or Preferred name of the Student
Mailing Address for the Student (Street, City, State, Zip) *
Date of Birth of the Student *
Name (First and Last) of Parent/Guardian registering the Student *
Phone number of the Parent/Guardian *
E-Mail address of the Parent/Guardian *
Home Parish/Congregation of the Student
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Student's Last Grade of School Completed *
Emergency Contact 1 (Name and Cell Phone Number) [In case the Parent/Guardian listed above can not be reached] *
Emergency Contact 2 (Name and Cell Phone Number) [Optional]
Does the Student have any Allergies (food, etc) and/or other Medical Conditions that the VBS staff should be aware of.
Photo Release:  By registering my child I understand that Grace Church (Episcopal) in Madison, NJ has permission to use my child’s photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *
At least one parent/guardian per family is needed to help with 'set up' and/or 'clean up' of VBS decorations/room arrangement/etc [Approximately 2 hours]. Please indicate which you will be helping with: *
Payment for registration can be made online at the Grace Church website, by mailing a check to the church office, or by placing a check in the offering basket/plate on Sundays. A donation to help cover the cost of supplies, etc is requested: $45 for 1 child, $80 for 2 children, $105 for 3+ children (per household). [NOTE: Scholarships are available if needed, please contact Father Asa for more info.] *
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