IPC ER PYPA NY VBS REGISTRATION 2025

VBS Registration Form 2025

The India Pentecostal Church of God Eastern Region PYPA and the Little Flock Pentecostal Church, NY are pleased to invite you to our VBS program. This year, our theme is "Diving into friendship with God", and we are excited to share the love of Jesus with your children. Our program will include various activities, such as biblical teachings, worship, and interactive sessions. We aim to provide your children with an unforgettable and meaningful experience that will help them in their Christian journey. Our VBS program will be held at the Little Flock Pentecostal Church from July 28 - 30, from 6 PM to 9 PM. Children between the ages of 4 and 14 are welcome to attend. Address: 49 Blake Ave, Lynbrook, NY 11563
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail*
example@example.com
Mobile Number*
Home Phone
Church Name*
Enter the name of the church you attend
Child #1 Information
Child #1 Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
T Shirt Size*
Select T Shirt Size
Grade in September 2025*
Allergies*

Please enter any allergies your child has. If none, please enter NONE0/500
Please let us know if your child has any special needs so we can better serve your child*

If no special needs, please enter NONE0/500
Will there be siblings attending the VBS?*

YesNo

Child #2 Information
Child #2 Name

First NameLast Name
Birth Date

MonthDayYear
Gender
T Shirt Size
Select T Shirt Size
Grade in September 2025
Allergies
Please enter any allergies your child has. If none, please enter NONE
Please let us know if your child has any special needs so we can better serve your child

If no special needs, please enter NONE0/500
Do you have another sibling that you would like to register for*

YesNo

Child #3 Information
Child #3 Name

First NameLast Name
Birth Date

MonthDayYear
Gender
T Shirt Size
Select T Shirt Size
Grade in September 2025
Allergies

Please enter any allergies your child has. If none, please enter NONE0/500
Please let us know if your child has any special needs so we can better serve your child

If no special needs, please enter NONE0/500

Parental Waiver and Release of Liability
Name of Parent or Legal Guardian*

First NameLast Name
Signature*

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Date*

MonthDayYear
Date

My Products

VBS Registration Fee $20Note: If you're using a Debit or Credit Card option for payment, you have the option to avoid creating a PayPal account. Simply disable the 'Save info & create your PayPal account' option located at the bottom of the PayPal screen, right after entering your Billing Address. If you have any questions, please contact us at 617-792-1941.

$20.00 Number of children attending VBS
Item subtotal:$0.00

Optional Donation If you would like to donate more for VBS, please donate here

$20.00
Item subtotal:$0.00

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Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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VBS Registration Form 2025

Child #1 Information

Child #2 Information

Child #3 Information

Parental Waiver and Release of Liability