BMC VBS Registration Form

2026 Burlington Methodist Church VBS

June 7th-11th, 2026

5:30p - 7p

Preschool - 6th Grade

STUDENT INFORMATION

Last Name

First Name

Birth Date

MonthDayYear

Gender

Have you previously attended VBS at BMC?

Grade completed by May 2026

Street Address

Street Address Line 2

City

Zip Code

EMERGENCY CONTACTS
Please list the first and last names and phone numbers off all adults who are allowed to pick up this child. Your child will only be released to these people.

Primary Guardian

First NameLast Name

Relationship to child

Phone Number

Area CodePhone Number

Alternate Guardian #1

First NameLast Name

Relationship to child

Phone Number

Area CodePhone Number

Alternate Guardian #2

First NameLast Name

Relationship to child

Phone Number

Area CodePhone Number

Medical Information

Please list all allergies and/or medical concerns -- or type "none" if there are none

Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)

Additional Information

VBS photos/videos are taken for promotional purposes related to Burlington Methodist Church and Vacation Bible School. These pictures may appear on our Facebook page, webpage and possibly on bulletin boards at the church. Do you allow your child to be included in these photos/videos?

By submitting this form, I ackowledge I have read and understand the above information.

Signature