Grace Community Church VBS
June 6th-10th, 2010
9:00AM - 12:00PM

Ages: 4 years - 5th grade

Please complete and mail or fax to Grace Community Church
or click the following link to register online:
https://www.groupvbspro.com/vbs/hl/gracehouston

1021 Campbell Road, Houston, TX 77055
Phone 713-465-4252 • Fax 713-465-1170

Please Print

Child's Name: ________________________________________________________________________

Child's age: __________ Date of birth: _____________ Last school grade completed: ____________

Name of parent(s): ____________________________________________________________________

Street address:_______________________________________________________________________

City: ____________________________________________ State: ___________ ZIP: ______________

Home telephone: (_______) ____________________________________________________________

Parents/caregiver's cell phone: ________________________________________________________

Home e-mail address: _________________________________________________________________

In case of emergency, contact: _________________________________________________________

Relationship to child: _________________________________________________________________

Allergies or other medical conditions: ___________________________________________________

Home church: _______________________________________________________________________

Crew number or name (for church use only): _____________________________________________