2025 VBS REGISTRATION FORM

2025 VBS REGISTRATION FORM

July 28th - 31th @ 6pm-8pm
AJALON MISSIONARY BAPTIST CHURCH

433 W Tramview Road, Palm Springs, CA 92262
Student's Name*

First NameLast Name
Parent/Family/Guardian Name*

First NameLast NameRelationship to Student
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Student Date of birth*

MonthDayYear
Date
Class room option*

K-1 GradeGrade 2-3Grade 4-6Grade 7-9Grade 10-12Adult
Home Church blanks. Friends of your child at this church blank
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?*

YesNo
Should be Empty: