2025 VBS Registration Form

Cincinnati Gospel Assembly Church

12055 Pippin Road Cincinnati Ohio 45231
2025 VBS Registration Form

For children ages 4 through 11
June 24 - 27

Tuesday - Friday ~ 6:30-8:30 pm
How many children are you registering?*
Child Information
First Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
Does the child attend Sunday school anywhere?*

YesNo
Where?
Medical or other information we may need to know about the child (including food allergies).*
First Child Shirt Size

XSSMLXLXXL
Second Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
Last Grade Completed
Does the child attend Sunday school anywhere?

YesNo
Where?
Medical or other information we may need to know about the child (including food allergies).
Second Child Shirt Size

XSSMLXLXXL
Third Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
Last Grade Completed
Does the child attend Sunday school anywhere?

YesNo
Where?
Medical or other information we may need to know about the child (including food allergies).
Third Child Shirt Size

XSSMLXLXXL
Child Release Information
Parent/Legal Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names of Persons to which the child (children) may be released to each night after VBS (Please provide at least two)*

First NameLast Name
Full Name*

First NameLast Name
Full Name

First NameLast Name
Full Name

First NameLast Name
Are there any persons to which the child (children) may NOT be released to?*

YesNo
Who may you child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 2 Phone Number*

Area CodePhone Number
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.

I Agree
Signature*

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Cincinnati Gospel Assembly Church

2025 VBS Registration Form

June 24 - 27

Child Information

First Child

Second Child

Third Child

Child Release Information

Media Release