Parent Name and Address

  
  
  

Emergency Contact Information

Authorized Individuals

Please list the names of any parent or approved guardian who you give permission to pick up your child during the week of VBS. Photo identification will be required at pickup.  

Use of Child(ren)'s Photo(s)

Check this checkbox if you do NOT want photos taken of your child(ren) to be displayed during VBS.
(Photos are never displayed with children's names).
  

Child 1

  

Child 2

  

Child 3

  

Child 4

  
 

    If you have problems registering or any questions, please call (610) 269-1421 or email us at retreatregistrar@gracechurchdowningtown.org.

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