VBS 2025 Child Registration Form

Welcome to Pilgrim VBS 2025!

Classes available for kids from pre-school up to Jr. High! Please submit one form per child.
STUDENT INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade in Fall 2025*
If younger than school age, write child's age.
Youth LYouth XLAdult SAdult MAdult L
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Emergency Contact Name
(If different from Parent/Guardian)
Emergency Contact Phone Number
(If different from Parent/Guardian)
Who is authorized to pick up your child from VBS? *
List all names of adults who may pick up your child from VBS
MEDICAL INFORMATION
Allergies or Medical Concerns
Church Information
Home Church
If no home church, leave blank
YesNo
YesNo
Should be Empty:

Church Information