Clone of 2025 VBS Registration Form

Vacation Bible School Registration Form
STUDENT INFORMATION
Name

First NameLast Name
M.I.
Birth Date

MonthDayYear
Date
Gender
Grade completed
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Siblings Enrolled in VBS *only one form needed for all kids, unless medically necessary*
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Alternate Guardian #1

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Alternate Guardian #2

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Medical Information
Please list all allergies -- or type "none" if there are none
Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)
Please list all medical concerns -- or type "none" if there are none
Additional Information
VBS photos/videos are taken throughout the duration of Vacation Bible School. These pictures may appear in various media outlets such as our facebook page and newsletter. Do you allow your child to be included in these photos/videos?
By submitting this form, I ackowledge I have read and understand the above information.
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Vacation Bible School Registration Form

Medical Information

Additional Information