VBS will take place June 16 and 17 from 9am - 3pm.

Kids must be between 5 and 14 years old. For kids that are close to 5 years old, please contact Oana Mogovan or Viorela Timoce.

Your financial donations/volunteering are greatly appreciated.
Text Viorela and let her know how you can help: 623-570-3935

Child Information

Child's First Name

Child's Last Name

Grade Completed

Age

5-14 years only

Birthday

YYYY

T Shirt Size

Food allergies/health concerns, if any

Parent Information

Parent's Names

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Emergency Contact

First Name

Last Name

Relationship to Child

Names and phone numbers of Person(s) Name(s) who may pick up the child if different from parents:

Which church do you attend?

I agree that in the event of any injury to the attendee, only the individual’s insurance will be used and I hereby release and hold harmless to Grace Romanian Pentecostal Church, its director, teachers, leaders, volunteers and any worker for this event. All liability, claims or demands for personal injury, property damage and expenses as a result from participation in these activities will be assumed by the above named child and his or her parent. *

I agree

Electronic Signature

Date

YYYY