Dates: June 25th – 29th
Time: 9:00 am – 12:00 pm
Location: 55 Franklin Street, Nashua
Ages: Entering grades 1-6

Child Registration Form (one per child)

Child Information

Name*

Gender*

Age*

Entering Grade*

Guardian Information

Name(s)*

Email Address*

Street Address*

City*

State*

Zip Code*

Release and Emergency

Please release my child(ren) to the following person(s) only*

Emergency Contact Person 1*

Emergency Contact Person 1 Cell Phone*

Emergency Contact Person 2*

Emergency Contact Person 2 Cell Phone*

Allergies or other medical conditions

Name of Pediatrician*

Pediatrician Phone Number*

In the event of an emergency, I give my permission for my child to be treated by a medical professional*

Other Information

I give permission for my child’s photographs or video footage to be uploaded on Gate City Church's website and/or social media*

How did you hear about VBS?