The Station Church VBS Registration Form 2026

The Station Church VBS Registration Form 2026

Please fill out the child's details, medical info, emergency contacts, and consent to participate and media use.
Child's Full Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Age
Sex
Grade Just Completed
Parent/Guardian Name

First NameLast Name
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address (if different)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code

Parent/Guardian Phone Numbers

Rows	Work	Home	Cell
Phone Number

Parent/Guardian Email
example@example.com
Medical Information or other information we need to know. (Please include any food allergies.)
Any special accommodation, behavior or sensitivities, etc. that our teachers should be aware ofto help them work with your child?
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I consent to allow any emergency medical care needed in the event of an accident or illness when such care is given by qualified emergency care providers. I further represent that I shall be responsible for all charges incurred. Also, I understand that as a participant, I or my child may be photographed or videotaped during normal special event activities, and these photos/videos may be used for promotional purposes. Parent/Guardian Signature____________________________________________________________________ Date _____________________________________________________ ________________
Parent/Guardian Signature
Should be Empty: