PRBC 2026 VBS Registration Form

Shine Bright In a Dark World!

Join us for Illumination Station VBS for the brightest week of the year! While many people claim to know about Jesus, many are in the dark about who He really is. During VBS kids will explore all the ways light brightens, illuminates, reflects, and reveals.
Parker Road Baptist Church, Vacation Bible School July 27 - July 31st, 2026. 8:45am - 12:15pm

PLEASE FILL OUT ALL FIELDS
Online Registration

Please note:

Seperate registration forms must be filled out for each child participating in Vacation Bible School.
Child's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Grade Just Completed and Age of Child
Birth Date

MonthDayYear
Sex
Attending with a daycare?
Yes or No
Name of Daycare. Children attending VBS with a Daycare must have parents or guardians information.
Parent/Guardian Information
Mother's Name

First NameLast Name
Father's Name

First NameLast Name
Guardian's Name (Put mother's or father's name if no guardian)

First NameLast Name
Mother's Phone Number
Format: (000) 000-0000.
Father's Phone Number
Format: (000) 000-0000.
Guardian's Phone Number
Format: (000) 000-0000.
Person's other than parents or guardians allowed to pick up the child. The parent or guardian's VBS card, or photo of it, is required in order to pick up the child.
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Emergency Contact Phone Number
Format: (000) 000-0000.
Do you attend a church?
Church name:
Does the child have any allergies or special needs. If yes, please describe.
May we have permission to photograph your child & post your child's picture on our social media? Yes or No?
Should be Empty:

Parker Road Baptist Church, Vacation Bible School July 27 - July 31st, 2026. 8:45am - 12:15pm