VBS 2018: Shipwrecked Rescued by Jesus
Dear Parents or Guardians:
Please fill out the information requested, then sign and return the Registration Form by 7/29/18 Sun.

Please submit your payment (cash or personal check) in person to either pastor Masao or pastor Ann or send your check to Next Generation Ministry 260 Elm Ave, Teaneck, NJ 07666 before 7/29/18.

Any questions can be submitted to GCCnextgeneration@gnncj.org

Details
Title: Group's Shipwreck rescued by Jesus
Date:8/22-8/24 (wed-fri)
Location: 260 Elm Ave, Teaneck, NJ 07666
Fee: $30 (full-day) $20 (half-day) Payable to: Grace Community Chapel
Ages: 2 1/2-4yo (9:30-12 Noon)
5 yo (kindergarten in Sept) - 6th Grade (9:30AM-3PM)

Lunch will be provided (allergy info required)

Age groups: 2.5 year old to 6th Graders (in September 2018)
Daily Themes:
Day 1: When you are lonely, Jesus rescues!
Day 2: When you worry, Jesus rescues!
Day 3: When you are powerless, Jesus rescues!Daily Themes:

Parent/Guardian 1 Information
Parent/Guardian - Full Name (1) *
Your answer
Parent/Guardian - Relationship to Child (1) *
Parent/Guardian - Home Phone Number (1) *
Your answer
Parent/Guardian - Cell/Work Phone Number (1) *
Your answer
Parent/Guardian - Email (1) *
Your answer
Parent/Guardian - Attending Church (1) *
Your answer
Parent/Guardian 2 Information
If applicable
Parent/Guardian - Full Name (2)
Your answer
Parent/Guardian - Relationship to Child (2)
Parent/Guardian - Home Phone Number (2)
Your answer
Parent/Guardian - Cell/Work Phone Number (2)
Your answer
Parent/Guardian - Email (2)
Your answer
Parent/Guardian - Attending Church (2)
Your answer
Emergency Contact
Emergency Contact - Full Name *
Your answer
Emergency Contact - Phone Number *
Your answer
Emergency Contact - Relationship to Child *
Your answer
Child 1's Information
Child's Name (1) *
Your answer
Child's Grade in Sept, 2018 (1) *
Child's Date of Birth (1) *
MM
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DD
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YYYY
Allergies or Other Concerns (1)
Your answer
Child 2's Information
If applicable
Child's Name (2)
Your answer
Child's Grade in Sept, 2018 (2)
Child's Date of Birth (2)
MM
/
DD
/
YYYY
Allergies or Other Concerns (2)
Your answer
Additional Children
If you are registering more than 2 children, use the space below to provide their Name, Grade in Sept, 2018, Date of Birth and any Allergies or Other Concerns
Additional Children Information
Your answer
Medical Insurance Information
Do you have medical insurance? *
If Yes, name your Insurance Provider
Your answer
ID Number
Your answer
Does your child have a special medical condition? *
If Yes, please explain
Your answer
Medical Release
I fully realize that injury or illness to my child may result from or during participation in the camp. In case of injury or illness, I give permission for my child to be given medical treatment as deemed appropriate. I further give permission for and grant authority to the camp representatives to sign on my behalf the Notice of Privacy Practice that patients are required to receive in accordance with federal law. I understand and acknowledge that I will be responsible for any medical bills incurred by my child at the VBS location, at a local hospital or elsewhere.
Signature *
Your answer
Date *
MM
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YYYY
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