Vacation Bible School 2026
New Home Baptist Church Perry, FL
June 22nd through June 26th 6:00pm - 8:35pm
Kids age 4yo - 6th grade
Child's Name
*
Child's First Name
Child's Last Name
Child's Birthdate
*
-
Month
-
Day
Year
Date
Child's Age
*
Last Grade Completed in School
Please Select
PreK - Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Child's Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Physical Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT / GUARDIAN INFORMATION
Parent/Guardian Registering the Child
*
Parent's First Name
Parent's Last Name
Parent/Guardian Mobile Number
*
Format: (000) 000-0000.
Parent/Guardian Home Number
Format: (000) 000-0000.
Parent/Guardian Work Number
Format: (000) 000-0000.
Parent/Guardian E-mail Address
example@example.com
Tell us ALL applicable Medical Information we need to know. (Include All Food and other allergies, special needs, etc.)
If NONE please indicate None
EMERGENCY CONTACTS
In the order you'd like them contacted if possible
Emergency Contact #1
*
Emergency Contact First Name
Emergency Contact Last Name
Emergency Phone #1
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact #2
First Name
Last Name
Emergency Phone #2
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact #3
First Name
Last Name
Emergency Phone #3
Please enter a valid phone number.
Format: (000) 000-0000.
DISMISSAL INFORMATION
Names and Numbers of whom is allowed to pick up your child besides yourself
Authorized Pickup #1
*
Auth P/U First Name
Auth P/U Last Name
Auth Pickup Phone #1
*
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup #2
First Name
Last Name
Auth Pickup Phone #2
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup #3
First Name
Last Name
Auth Pickup Phone #3
Please enter a valid phone number.
Format: (000) 000-0000.
Does your child attend church? If so, where?
Name of Church
How often does your child attend church?
*
Weekly
Couple of times a month
Few times a year
N/A
If your child is visiting our church, who is he/she a guest of?
Name of person who invited your child to VBS
May we photograph your child during VBS?
*
Please Select
YES
NO
May we photo your child and use it in a graduation slideshow and social media?
*
Please Select
YES
NO
SUBMIT
Should be Empty: