VBS Registration

VBS Registration

2026
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Last Grade Completed in School:*
Parent's Email*
example@example.com
Parent/Guardian's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Medical or other information we need to know (Please include any food allergies):*
Emergency Contacts:
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.
Do you go to church? If so, where?*
My child's likeness may be included in photographs and videos taken during church activities that may be published in the following media: Commercial newspapers, television news media, church website or other publications including social media.*
VBS RELEASE INFORMATION (Persons responsible for picking up the child - must be 18 years old or older)
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.
If there are any custody issues, please let us know.
For teacher use only:

Sun. ____Mon. ____ Tues. ____ Wed. ____ Thurs. ____ Fri.____
Should be Empty:

Emergency Contacts: