Registration Form
VBS 2025
Child's Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Information
Home Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Birth Date
-
Month
-
Day
Year
Date
Last grade completed in school
Medical Information
Medical or other information we need to know. (Please inclide any food allergies.)
Emergency Contact
Other than listed above! Name and Phone numbers
Dismissal Information
Who may pick up your child at the end of each VBS day?
Other Information
Does your child attend church? If so, where?
If your child is visiting our church, who are they a guest of?
May we have permission to photograph your child?
Yes or NO
May we have permission to use your child's photograph for the purpose of promotion?
Yes / No
Submit
Should be Empty: