Student Registration Form

Please use this VBS registration form for children 4 years old by September 30th of this year to entering grade 6. Please enter the grade your child WILL BE entering in the fall (next school year).

We rotate through a schedule and various locations - students must be day time (8:30 - noon) potty trained to attend. Unsure if your 4 year old is ready for VBS? Please contact Jenni Whitford at jwhitford@granpres.org

Student Registration Form:

Please complete one registration per child. This form will be used as the emergency contact form during VBS.

First Name

Last Name:

Date of Birth:

Age

Grade Entering

Please specify the days your child will be in attendance at VBS.

ALL DAYS M-F

Monday

Tuesday

Wednesday

Thursday

Friday

Gender:

Parent / Guardian:

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone:

(###)

###

####

Email:

Please choose your child's T-Shirt size (Unisex Sizes - Poly/Cotton 50/50):

Please check if you DO NOT GIVE PERMISSION TO PHOTOGRAPH YOUR CHILD, for use by Granville VBS:

I DO NOT GIVE PERMISSION

Dismissal Information:

Persons other than parent/guardian authorized to pick up your child from VBS:

Emergency Medical Information:

Please explain in detail any special needs, food allergies or medical conditions of which we need to be aware. Include in detail symptoms to watch for, actions to be taken, specific instructions of any needed medications (including epi-pens), and follow-up procedures:

Emergency Release:

Granville Ecumenical VBS has a volunteer nurse each morning to help us provide the safest environment for all participants. Every effort will be made to notify parents of any concerns. However, if there should be a need for medical care and we are not able to reach the parent, and the incident is beyond the scope of our nurse, we want to access the care needed through our Granville Fire Department and Emergency Squad:

Please choose one of the following:

As the parent / guardian I GIVE consent to transport my child to Licking Memorial Hospital or a facility recommended by the Granville Fire Dept. for treatment

As the parent / guardian I DO NOT GIVE my consent for treatment

Please List 2 (non-parent) People We Can To Notify if We Cannot Reach a Parent:

1st (non-parent) Emergency Contact Name:

First Name

Last Name

Relationship:

Phone:

(###)

###

####

2nd (non-parent) Emergency Contact Name:

First Name

Last Name

Relationship:

Phone:

(###)

###

####

After you have registered all of your students for VBS - Don’t forget the last step….CLICK RegistrationPayment Page Button below.

registration payment page