2025 Vacation Bible School Registration (YOUTH)
June
Youth Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Youth Age
*
Youth Gender
Please Select
Male
Female
Youth Phone#
Please enter a valid phone number.
Format: (000) 000-0000.
Last school grade completed
Please Select
6th
7th
8th
9th
10th
11th
12th
Parent/Guardian name
*
Parent/Guardian phone#
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Email
example@example.com (only used for VBS correspondence
Home church
List all allergies, medical conditions, or any special needs
In case of an emergency, contact name
Emergency contact phone#
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency contact relation to youth
Bus Pickup
Please Select
YES
WacoBC has a bus ministry that will be running during VBS. Select YES if you need bus pickup for your child or children.
Submit
Should be Empty: