RALEIGH SDA - VBS 2025 REGISTRATION

RALEIGH SDA - VBS 2025 REGISTRATION

SUBMIT ONE REGISTRATION FOR EACH CHILD
WHEN: July 21-25, 2025

9AM-12PM

WHERE: Raleigh SDA Church, ARC Building

4805 Dillard Ave, Raleigh, NC 27606

WHO: Children 4-12 years old

SUGGESTED DONATION: $20

Cash or check (payable to Raleigh SDA Church)
Complete and submit form to register your child

(* indicates a required field).
Child's Name*

First NameLast Name
Child's Age*
At time of VBS program (4-12)
Shirt Size*

XS (Child 2-4)S (Child 6-8)M (Child 10-12)L (Child 14-16)S (Adult)M (Adult)L (Adult)XL (Adult)
Parent/Guardian Name (Emergency Contact)*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AUTHORIZED PICK-UP
Please let us know who else is authorized to pick up your child from VBS. If there is a concern with the dismissal of your child(ren), please speak with the director.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship
Example: Father, Mother, Friend, etc
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship
Example: Father, Mother, Friend, etc
ALLERGIES
Does your child have any allergies?*

NoneSeasonalBee StingsFoodOther
Please describe your child's allergies. If your child has a food allergy, we ask that you provide a snack for your child each day (be sure to label the daily snack with your child's name).
Allergies
Will your child bring an EpiPen to VBS? (Note: EpiPens MUST be checked in with the director on the first day of attendance, and they MUST come with the original label and box from the pharmacy.)

YesNo
SPECIAL NEEDS
Does your child have special needs that require one-on-one attention?*

YesNo
If so, please explain:
Days your child will attend VBS?*

Monday, July 21Tuesday, July 22Wednesday, July 23Thursday, July 24Friday, July 25
ACKNOWLEDGE AND UNDERSTAND*

By sending your child to VBS, you understand that throughout VBS week, photos/videos are taken of the children. These photos/videos may be shared with local newspapers, posted on social media, the churches website/bulletin boards, etc
Name*

First NameLast Name
Signature*

Clear
Should be Empty:

RALEIGH SDA - VBS 2025 REGISTRATION

AUTHORIZED PICK-UP

ALLERGIES

SPECIAL NEEDS