Knox Grace EC VBS 2021 Registration

Please fill out this form and click submit.

Contact Information

Full Name of Student

*

Parents/Guardian

*

Family Email

*

This address will receive a confirmation email

Home Phone

*

Cell Phone

Mailing Address

*

Grade Completed or Age if not in school

*

Please select one option.

Age 3 Age 4 Age 5 Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade

Gender

*

Please select one option.

Male Female

Emergency & Medical

Does your child have allergies? Please tell us what we need to know to keep them healthy and safe.

Select all that apply:

*

Please select one option.

Food Medical Environmental None

Describe Food allergies

Describe Environmental allergies

Special Needs:

Emergency Contact

*

Emergency Contact Phone #

*

Authorized Pick Up

Please tell us who is allowed to sign your child out of VBS. We will not release your child to anyone who is not listed.

Authorized Persons:

*

Additional Information

Use this section for additional important information concerning your child's needs:

Additional Information:

Description

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