2026 VBS REGISTRATION FORM
July 27th - 30th @ 6pm-8pm
AJALON MISSIONARY BAPTIST CHURCH
433 W Tramview Road, Palm Springs, CA 92262
Student's Name
*
First Name
Last Name
Parent/Family/Guardian Name
First Name
Last Name
Relationship to Student
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Student Date of birth
-
Month
-
Day
Year
Date
Class room option
*
K-1 Grade
Grade 2-3
Grade 4-6
Grade 7-9
Grade 10-12
Adult
Allergies/Medical Information/Other - Please apply none if does not apply
*
Emergency Contacts
*
Name(s) of person(s) who may pick up student from VBS
May we use your child photograph for VBS promotion?
Yes
No
Submit
Should be Empty: