Illumination Station VBS 2026 Registration – Fellowship Baptist Church

Illumination Station VBS 2026 Registration – Fellowship Baptist Church

Fellowship Baptist Church, 1029 Halifax Road, Danville, VA 24540 | Dates: June 22–26, 2026 | Time: 6:00 PM–8:00 PM | Ages: Preschool–Completed 5th Grade | Dinner Included | Theme: Illumination Station
Child’s Name
Date of Birth

MonthDayYear
Date
Age
Grade Completed
Gender
Child 2 Name
Child 2 Date of Birth

MonthDayYear
Date
Child 2 Age
Child 2 Grade Completed
Child 2 Gender
Child 2 Photo Permission
Child 2 Allergies (food, medication, etc.)
Child 2 Medical Conditions
Child 2 Special Needs/Instructions
Child 3 Name
Child 3 Date of Birth

MonthDayYear
Date
Child 3 Age
Child 3 Grade Completed
Child 3 Gender
Child 3 Photo Permission
Child 3 Allergies (food, medication, etc.)
Child 3 Medical Conditions
Child 3 Special Needs/Instructions
Parent/Guardian Name(s)
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Relationship to Child
Allergies (food, medication, etc.)
Medical Conditions
Special Needs/Instructions
Authorized Pick-Up Person 1
Authorized Pick-Up Person 2
Authorized Pick-Up Person 3
Photo Permission
Do you have a church home?
If yes, where do you attend?
I am the parent/guardian of the above-named child and give permission for my child to attend VBS at Fellowship Baptist Church.
Parent/Guardian Name (for consent)
Today’s Date

MonthDayYear
Date
Should be Empty: