"ILLUMINATION STATION VBS PRE-REGISTRATION FORM"
JULY 13-16, 2026 5:30 PM - 8:00 PM
Parent / Guardian Name
First Name
Last Name
Home & Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Information
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Name
First Name
Last Name
Child's Age and Last Grade Completed
Medical Information or Other that we need to know. (Please include any food allergies.)
Emergency Contacts (other than listed above) Names and Numbers
Who may pick up your child at the end of each VBS day?
Does your child attend church? If so, where?
If your child is visiting our church, who is he or she a guest of?
May we have permission to record video and take photos of your child participating during the VBS group stations, sessions, and/ or assembly for our Church YouTube account for the purpose of promotion?
Please Select
Yes
No
Submit
Should be Empty: