VBS REGISTRATION FORM

Student Information

Name

First NameLast Name

Grade Entering in 2026/2027 School Year

Please list the names of any other children (friends or family) that you would like placed in the same class as this child. (Groups will be split by age.)

Medical Information

Please list all allergies -- or type "none" if there are none

Please list all medical concerns -- or type "none" if there are none

Do you have another child to register?

Student 2 Name

First NameLast Name

Grade Entering in 2026/2027 School Year

Please list the names of any other children (friends or family) that you would like placed in the same class as this child. (Groups will be split by age.)

Student 2 Medical Information

Please list all allergies -- or type "none" if there are none

Please list all medical concerns -- or type "none" if there are none

Do you have another child to register?

Student 3 Name

First NameLast Name

Grade Entering in 2026/2027 School Year

Please list the names of any other children (friends or family) that you would like placed in the same class as this child. (Groups will be split by age.)

Student 3 Medical Information

Please list all allergies -- or type "none" if there are none

Please list all medical concerns -- or type "none" if there are none

Do you have another child to register?

Student 4 Name

First NameLast Name

Grade Entering in 2026/2027 School Year

Please list the names of any other children (friends or family) that you would like placed in the same class as this child. (Groups will be split by age.)

Student 4 Medical Information

Please list all allergies -- or type "none" if there are none

Please list all medical concerns -- or type "none" if there are none

Family Information

Parent/Primary Guardian

First NameLast Name

Primary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Secondary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Church (if any)

Emergency Contact

Is Emergency Contact or Person Picking up Child(ren) different than Parent/Primary Caregiver listed above?

Please list Emergency Contact or Approved Pick-Up Person:

First NameLast Name

Relationship to Child(ren)

Phone Number

Format: (000) 000-0000.

Additional Information

I understand that photographs and videos may be taken during this event and that my child may appear in group or candid images used for church-related purposes such as social media, websites, printed materials, and presentations. I acknowledge that while efforts may be made to honor photo restrictions, it may not be possible to fully exclude individuals from all group photos or video.

By submitting this form, I ackowledge I have read and understand the above information.

Signature