Vacation Bible School Registration
August 3rd -August 7 ,2026 from 5:30-7:30 PM Location:Curtis Baptist Bible Church, 4297 Tannery Rd. Campbell, NY 14821 Brought to you by Campbell Community Bible Church, Curtis Baptist Bible Church, and Thurston Christian Church.
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Completed
Pre K
Kindergarten
First
Second
Third
Fourth
Fifth
Gender
Boy
Girl
Food Allergy/ Medical Concerns
Additional Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Completed
Pre K
Kindergarten
First
Second
Third
Fourth
Fifth
Gender
Boy
Girl
Food Allergy/ Medical Concerns
Additional Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Completed
Pre K
Kindergarten
First
Second
Third
Fourth
Fifth
Gender
Boy
Girl
Food Allergy/ Medical Concerns
Parent/Guardian
First Name
Last Name
Cell Number
Please enter a valid phone number.
Format: (000) 000-0000.
Alternative Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternative Emergency Contact Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Child (Children)
May they pick up your child (children)
Yes
No
Names of Additional Individuals who may pick up your child/children.
If Applicable
Home Church (if applicable)
Additional comments/information
Permission to Treat
I, the parent/guardian, give permission to my child/children to attendVacation Bible School located at Curtis Baptist Bible Church on 4297 Tannery Rd in Campbell and authorize the VBS staff and volunteers to seek medical attention for my child/children in the event of an emergency. I understand that the VBS staff and volunteers will make every effort to contact me or my designated emergency contact before doing so.
Signature
Permission to Use Images and Video
I, the parent/guardian, of the child/children listed, grant the Vacation Bible School staff and volunteers to record sounds, images, or video of my child while attending the VBS program. I also give permission, at their sole discretion, to use sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Curtis Baptist Bible Church and/or Campbell Community Bible Church in relation to this VBS.
Signature
Submit
Should be Empty: