VBS 2017: Maker Fun Factory Registration
Dear Parents or Guardians:
Please fill out the information requested, then sign and return the Registration Form by 5/28/17 Sun.

Please submit your payment (cash or personal check) in person to either pastor Jee or pastor Ann or send your check to Next Generation Ministry 260 Elm Ave, Teaneck, NJ 07666 before 5/26.

Any questions can be submitted to GCCnextgeneration@gnncj.org

Details
Date: July 5-7, 2017 (Wed-Fri)
Time:
9:30am-3:00pm (For ages 5-up)
9:30am-12:30PM (3-4 yo)
(Kids with older siblings who are attending full day camp can stay until 3PM)

Registration fee: $ 20 per child

Payable to: Grace Community Chapel

Lunch will be provided (allergy info required)

Location: 260 Elm Ave, Teaneck, NJ 07666

Age groups: 2.5 year old to 5th Graders (in September 2017)

Daily Themes:
Day 1: God made you
Day 2: God is always with you
Day 3: God made you for a reason

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, 2017 (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, 2017 (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, 2017, 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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