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VBS 2024
Participant Registration
June 17-21, 2024
9am-12pm, Mon-Thurs
9am - 12:15pm, Fri
General Information
Number of Children You Are Registering
*
Please Select
1
2
3
4
5
6
Child #1 Section
Child #1
Full Name
*
First Name
Last Name
Birth Date:
*
/
Month
/
Day
Year
Date Picker Icon
Age:
as of VBS start date
School Grade (next year!)
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
as of Sept. 2022
Gender
*
Male
Female
Child #2 Section
Child #2
Full Name
*
First Name
Last Name
Birth Date:
*
/
Month
/
Day
Year
Date Picker Icon
Age
as of VBS start date
School Grade (next year!)
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
as of Sept. 2022
Gender
*
Male
Female
Child #3 Section
Child #3
Full Name
*
First Name
Last Name
Birth Date:
*
/
Month
/
Day
Year
Date Picker Icon
Age
as of VBS start date
School Grade (next year!)
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
as of Sept. 2022
Gender
*
Male
Female
Child #4 Section
Child #4
Full Name
*
First Name
Last Name
Birth Date:
*
/
Month
/
Day
Year
Date Picker Icon
Age
as of VBS start date
School Grade (next year!)
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
as of Sept. 2022
Gender
*
Male
Female
Child #5 Section
Child #5
Full Name
*
First Name
Last Name
Birth Date:
*
/
Month
/
Day
Year
Date Picker Icon
Age
as of VBS start date
School Grade (next year!)
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
as of Sept. 2022
Gender
*
Male
Female
Child #6 Section
Child #6
Full Name
*
First Name
Last Name
Birth Date:
*
/
Month
/
Day
Year
Date Picker Icon
Age
as of VBS start date
School Grade (next year!)
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
as of Sept. 2022
Gender
*
Male
Female
Parent/Guardian Section
Parent/Guardian Info:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Home Phone
*
Work Phone
Cell Phone
E-mail
*
Medical/Allergy/Emergency Contact Information
Medical Conditions:
Any medical conditions about your child that will help us should an emergency occur.
Known Allergies:
Any known allergies that your child has that will help direct us in making decisions for your child.
Special Needs:
Does your child have special needs? If so please specify.
Other Helpful Info:
Any other helpful medical or behavioral conditions about your child that will be helpful to us, or anything you want us to know.
Emergency Contact Name #1:
*
First Name
Last Name
Emergenct Contact Phone #1:
*
Emergency Contact is same as Parent/Guardian?
Yes
Emergency Contact Name #2:
First Name
Last Name
Emergenct Contact Phone #2:
Authorized Pickup Person(s)
Pick-up person a volunteer at VBS?
Yes
Pick-up person same as Parent/Guardian?
Yes
NAME: Authorized Pickup #1
*
First Name
Last Name
PHONE: Authorized Pickup #1
*
NAME: Authorized Pickup #2
First Name
Last Name
PHONE: Authorized Pickup #2
*
NAME: Authorized Pickup #3
First Name
Last Name
PHONE: Authorized Pickup #3
*
NAME: Authorized Pickup #4
First Name
Last Name
PHONE: Authorized Pickup #4
*
Church
Affiliation
Church Member status:
Please Select
Active Church Member
Inactive Church Member
Active Church Attender
Does Not Attend Church
Church Affiliation:
Name of home church (if any)
Guest Of: (optional)
First Name
Last Name
PHOTOS: Many times we have the opportunity to take pictures of children during VBS and try to capture the fun and meaningful moments throughout the week. These photographs may be used for flyers, church publications, our end-of-the-week movie. Individual names will not be associated with any picture taken.
*
Yes, I give permission for my child's picture to be used
No, I do not want my child included in any pictures
Choose days your child(ren) will attend:
Monday, 06/17/2024, 9am-12pm
Tuesday, 06/18/2024, 9am-12pm
Wednesday, 06/19/2024, 9am-12pm
Thursday, 06/20/2024, 9am-12pm
Friday, 06/21/2024, 9am-12:15pm
How did you hear about VBS?
Church
Outdoor Sign
Website
Facebook
Friend
Other
Comments/Questions
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