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VBS 2010
 
To register for the Great Kid Mission Adventure Camp, you may download and complete the application form, or use the conveinient online form below.
 
Online Registration Form
* denotes required field
 
Parent/Guardian Information
* Parent/Guardian Name
* Street Address
* City
* State
* Zip Code
* Home Phone
Cell Phone
Work Phone
Email
 
Child Information - Must be 3 years old by June 1 and potty-trained.
 
Child #1
* First Name   * Last Name  
* Birthdate
(mm/dd/yyyy)   		* Age   * Last Grade Completed  
 
Child #2
First Name   Last Name  
Birthdate
(mm/dd/yyyy)   		Age   Last Grade Completed  
 
Child #3
First Name   Last Name  
Birthdate
(mm/dd/yyyy)   		Age   Last Grade Completed  
 
Medical Information
Please provide any medical or other information we need to know, including any food allergies.
 
Emergency Contact Information
* Name * Relation * Phone
Name Relation Phone
 
Dismissal Information
Who has permission to pick up your child at the end of each evening/phone?
 
Photographic Permission
May we have permission to photograph your child?  Yes
May we have permission to use your child’s photograph in church publications for the purpose of promotion?  Yes