Clone of Vacation Bible School Registration Form

VBS Registration Form

We’re excited to invite your child to Vacation Bible School 2026 at Headland Methodist Church! This year’s theme is “Farm Fresh Faith,” and we have a fantastic week planned full of barnyard fun, Bible stories, music, crafts, and games. VBS will take place from June 7th through June 10th at 103 West King Street, beginning with supper each evening at 5:30 PM followed by our main program from 6:00 PM to 7:45 PM. The program is open to children entering K4 through 5th grade. Please complete the registration form below to secure your child’s spot, being sure to include important details like emergency contacts, allergies or medical conditions, and authorized pick-up individuals. We look forward to sharing this joyful week of faith, fellowship, and farm fun with your family!
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of Child 1

First NameLast Name
Last Grade Completed
Child 1's Birthdate

MonthDayYear
Date
Name of Child 2 (If registering more than 1 child)

First NameLast Name
Last Grade Completed
Child 2's Birthdate

MonthDayYear
Date
Name of Child 3 (If registering more than 1 child)

First NameLast Name
Last Grade Completed
Child 3's Birthdate

MonthDayYear
Date
Name of Child 4 (If registering more than 1 child)

First NameLast Name
Last Grade Completed
Child 4's Birthdate

MonthDayYear
Date
Home Church
Please list any allergies or other medical conditions for each child.
Authorized Pickup Persons (Please list names, relationship to the child, and phone numbers)
Liability Waiver & Consent for Medical Treatment

As the parent or legal guardian of my child, I give permission for my child to participate in the Headland Methodist Church Vacation Bible School (VBS) Program, taking place June 8–11, 2025. I understand that Headland Methodist Church is a nonprofit charitable institution offering this program voluntarily for the benefit of children, participants, and the community.

I acknowledge that the VBS program may involve physical activity, contact with other participants, use of equipment, and movement around the church campus. I understand that there is a risk of physical injury involved, and I affirm that my child is in proper physical condition with no known injuries or conditions that could pose a safety concern.

By submitting this form, I release and discharge Headland Methodist Church, including its staff, volunteers, and representatives, from any and all liability for harm or injury to my child, whether directly or indirectly caused, including those that may result from negligence. I also give permission for church staff or volunteers to administer first aid or seek emergency medical care for my child if necessary during participation, including transportation to a medical facility if appropriate.
I have read and agree to the Liability Waiver & Consent for Medical Treatment above.
Media Release

I authorize Headland Methodist Church Vacation Bible School (HMC VBS) staff and representatives to record and photograph my child during VBS activities. I understand that these images or recordings may be used in church-related materials including, but not limited to, social media, websites, newsletters, advertisements, postcards, and church event promotions. I agree to allow the use of my child’s image or likeness for these purposes.
I agree to the Media Release terms above.
Should be Empty:

VBS Registration Form