Clone of VBS 2025 Child Registration

CHILD REGISTRATION

VBS will be held on June 22-25 from 6:30-8:45 p.m. Please complete this form for children that have finished Kindergarten-5th grade as thoroughly as possible. You may register up to 5 children from the same family using this form.
Family Last Name*
Parent/Guardian 1*

First NameLast Name
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Phone Number*

Area CodePhone Number
Parent/Guardian 2

First NameLast Name
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Phone Number

Area CodePhone Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where does your family attend church?*

Parkgate Community ChurchDon't attendOther
How did you hear about our VBS?*
How many children are you registering to attend VBS?*

12345
CHILD #1 INFORMATION
Child's Name*

First NameLast Name
Gender*

MaleFemale
Fall 2026 Grade/Age*

1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Children must be potty-trained in order to attend VBS. Thanks!
Preferred Name
Birth Date*

MonthDayYear
In the box below, you may write the name of a friend your child would like to be in class with. While we do our best to accomodate these requests, we cannot make any guarantees.
Friend's Name
First & Last Name
CHILD #2 INFORMATION
Child's Name*

First NameLast Name
Gender*

MaleFemale
Fall 2026 Grade/Age*

1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Children must be potty-trained in order to attend VBS. Thanks!
Preferred Name
Birth Date*

MonthDayYear
In the box below, you may write the name of a friend your child would like to be in class with. While we do our best to accomodate these requests, we cannot make any guarantees.
Friend's Name
First & Last Name
CHILD #3 INFORMATION
Child's Name*

First NameLast Name
Gender*

MaleFemale
Fall 2026 Grade/Age*

1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Children must be potty-trained in order to attend VBS. Thanks!
Preferred Name
Birth Date*

MonthDayYear
In the box below, you may write the name of a friend your child would like to be in class with. While we do our best to accomodate these requests, we cannot make any guarantees.
Friend's Name
First & Last Name
CHILD #4 INFORMATION
Child's Name*

First NameLast Name
Gender*

MaleFemale
Fall 2026 Grade/Age*

1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Children must be potty-trained in order to attend VBS. Thanks!
Preferred Name
Birth Date*

MonthDayYear
In the box below, you may write the name of a friend your child would like to be in class with. While we do our best to accomodate these requests, we cannot make any guarantees.
Friend's Name
First & Last Name
CHILD #5 INFORMATION
Child's Name*

First NameLast Name
Gender*

MaleFemale
Fall 2026 Grade/Age*

1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Children must be potty-trained in order to attend VBS. Thanks!
Preferred Name
Birth Date*

MonthDayYear
In the box below, you may write the name of a friend your child would like to be in class with. While we do our best to accomodate these requests, we cannot make any guarantees.
Friend's Name
First & Last Name
ADDITIONAL FAMILY INFORMATION
Do any of your children have dietary restrictions? If yes, please list the child's name and give details in the box below.*

YesNo
Dietary Restrictions
Do any of your children have allergies? If yes, please list the child's name and give details in the box below.*

YesNo
Allergies
Do any of your children have other special needs we should be aware of (i.e. epilepsy, autism, behavioral concerns, etc.)? If yes, please list the child's name and give details in the box below.*

YesNo
Other Special Needs
EMERGENCY CONTACT INFORMATION

Please provide information for two emergency contacts for your child the week of VBS. This may be the parent/guardian indicated above or another individual providing your child care during VBS.
Contact #1 Name*

First NameLast Name
Contact #1 Phone*

Area CodePhone Number
Relation to Child*
Contact #2 Name*

First NameLast Name
Contact #2 Phone*

Area CodePhone Number
Relation to Child*
PHOTO RELEASE POLICY

Parkgate Community Church will be photographing/filming students throughout the week at VBS. By selecting yes, I understand that my children's photographs may be presented in an array of multimedia formats both online and in print. This includes our Facebook Page, where you may be taggged.

I recognize that by selecting no, my children will not be included in their class group photo.
Do you agree to Parkgate Community Church's Photo Release Policy?*

YesNo
EMERGENCY TREATMENT

By typing my name in the box below, I grant all of the children registered on this form permission to participate in all VBS activities. In the event of an emergency where medical treatment is required, I give my permission to the Parkgate Community Church staff and/or VBS volunteers to obtain the services of a licensed physician. In the event that I cannot be readily contacted, I hereby authorize any medical teatment that may be necessary to be administered to my children. I understand that I will be responsible for any costs incurred. I recognize that Parkgate Community Church will not be held responsible for any injuries occured during VBS.
Electronic Signature:*

First NameLast Name
Should be Empty: