Grace Temple Baptist Church
Secure Online Form

Grace Temple Baptist Church

2020 VBS Registration

(One Per Adult or Child Paticipant)


Name:          Gender:

**  Required Information for a child

Optional for Adults, Age range select one

** Child's age:              ** Date of Birth:         ** Last school grade completed  

** Name of parent(s):

Street address:     

City:                          State:   Zip code:       

Home Phone:              Parent/caregiver's cell phone:   

Email Address:     

Home church:       

Parent (s) work number:                     

Allergies or other medical conditions:  

In case of emergency contact name:   

Emergency contact number :              



Registration information will be submitted to: