VBS 2026 Registration Form
July 27-31,2026
Heritage Baptist Church- 345 Darlington Street East
9:15 am- 11:30 am
(One Per Child)
Name
*
LAST Name
FIRST Name
Age:
*
Grade:
*
Date of Birth:
*
-
Month
-
Day
Year
Date
Name of Parent(s)/Guardian(s):
*
Street Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Telephone:
*
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
Email Address:
*
example@example.com
Home Church (If Applicable):
Allergies / Medical Conditions:
*
Type "None" for no conditions
Emergency Contact Name:
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Child:
*
Health Card Number
I give permission for my child's photo to be used in a slide show at the end of the week. Y or N
*
Yes
No
Parent Signature:
*
Preview PDF
Submit
Should be Empty: