2026 VBS Registration Form

2026 VBS Registration Form

Illumination Station - JESUS IS THE LIGHT OF THE WORLD!!
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Child's Age
Last Grade Attended
Parent/Legal Guardian's Name

First NameLast Name
Mobile Number
Format: (000) 000-0000.
Email Address
example@example.com
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Church (Optional)
Please provide any medical or dietary restrictions child has:
I give my permission to use my child's photo on promotional media.
How did you hear about Camp?

Pickup Information

Who besides Parent/Legal Guardian listed above can pick child up from camp?
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Emergency Information
Medical or other information we may need to know about the child (including food allergies).
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Relationship to Student
Should be Empty:

Pickup Information