VBS Form

VACATION BIBLE SCHOOL

June 22-26, 2026
Child's Name

First NameLast Name
Child's Gender
Child's Date of Birth
Child's Age
PreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade & Up (for VBS helpers)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name

First NameLast Name
Mother's Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Email
example@example.com
Father's Name

First NameLast Name
Father's Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact

First NameLast Name
Relationship to Child
Emergency Contact's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Condition/Special Needs:
Allergies (please specify) blanks
Other (please specify): blank
Home Church
Cost

There is a $15 registration fee for each child payable on the first day at registration check-in
MEDICAL RELEASE:

I give my permission for the St. Peter's VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the St. Peter's VBS staff will contact emergency services in the event of a significant injury and all expenses for such services will be paid by me.
Signature

Clear
Should be Empty:

VACATION BIBLE SCHOOL