VBS 2026
June 15th-19th,
9am-12pm
Closing Celebration
Sunday, June 21st at 10:45am
Registration
Child #1 Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Gender
Please Select
Male
Female
Last Grade Completed
Please list any health conditions, allergies, or other concerns we should be aware of
Name of friend you wish to be in a group with
Child #2 Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Gender
Please Select
Male
Female
Last Grade Completed
Please list any health conditions, allergies, or other concerns we should be aware of
Name of friend you wish to be in a group with
Child #3 Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Gender
Please Select
Male
Female
Last Grade Completed
Please list any health conditions, allergies, or other concerns we should be aware of
Name of friend you wish to be in a group with
Child #4 Name
First Name
Last Name
Age
Birth Date
-
Month
-
Day
Year
Gender
Please Select
Male
Female
Last Grade Completed
Please list any health conditions, allergies, or other concerns we should be aware of
Name of friend you wish to be in a group with
Family Information
Mother's Name
First Name
Last Name
Cell Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father's Name
First Name
Last Name
Cell Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address (if different than above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
-
Area Code
Phone Number
Home Church
Do we have your permission to photograph your child(ren) during VBS?
Yes
No
Emergency Contact
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Submit
Should be Empty: