Salem Baptist Church VBS Registration Form
June 7 - 11, 2026 5:30 - 8:30 PM
Child Participating
*
Is this your child's first time attending?
Yes
No
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship to Child (e.g., parent, grandparent, aunt/uncle, family friend):
My child may be picked up by the following individuals.
*
Please list any allergies or medical conditions
*
I consent to my child's participation in the VBS program.
*
Yes
No
I consent & give permission for the use of photographs or videos of my child taken while at Salem Baptist Church during VBS.
*
Yes
No
I authorize the Salem VBS staff to seek emergency medical treatment for my child if necessary.
*
Yes
No
By signing below, I grant permission for my child(ren) to participate in Vacation Bible School at Salem Baptist Church. In the event of an emergency, I authorize church staff or volunteers to obtain medical treatment for my child(ren). I certify that the information provided on this form is true and accurate.
*
Submit
Should be Empty: