2026 VBS Registration Form (Ages 4-12)
Please fill out this form to complete the VBS waiver.
Child's Name
*
First Name
Last Name
Child's Age
*
Child's Gender
*
Male
Female
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name/Phone Number Of Others Authorized To Pick Up Your Child
*
Please list any allergies or medical conditions
*
Home Church
*
I consent to my child's participation in the VBS program.
*
Yes
No
I authorize the VBS staff to seek emergency medical treatment for my child if necessary.
*
Yes
No
Occasionally we snap pictures of children's events. If you WOULD NOT like your child's photo to be shared please let us know here.
*
Yes
No
By signing this form, I agree to release and hold harmless the VBS program, staff, and volunteers from any claims or liability arising from my child's participation.
*
Submit
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