Vacation Bible School Registration Form

Illumination Station Second Baptist Church — Vacation Bible School Registration Form

please fill out your child's details to register.
Illumination Station Second Baptist Church
Child's Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Child's Age
Grade completed
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies or Medical Conditions
Should be Empty:

Illumination Station Second Baptist Church — Vacation Bible School Registration Form