Child Vacation Bible School Registration
Online registration for Malaby's Crossroads Missionary Baptist Church VBS. Please complete all required fields and use the form to provide child, parent/guardian, emergency contact, medical, transportation, permission, referral, and signature information. The form also includes an internal church-use-only section.
Participant (Child) Information
Child's Full Legal Name
*
First Name
Middle Name
Last Name
Preferred Name / Nickname
Date of Birth
*
-
Month
-
Day
Year
Date
Age
Grade Completed
*
School Attending
Home Address
*
City
*
State
*
Zip Code
*
T-Shirt Size
Please Select
Youth XS
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Other
T-Shirt Size (Other, Specify)
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Relationship to Child
*
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contacts
Emergency Contact Name
*
First Name
Last Name
Relationship to Child
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Emergency Contact Name
First Name
Last Name
Alternate Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Medical/Health/Special Needs
Allergies
No known allergies
Food allergies
Medication allergies
Environmental allergies
Insect stings
Other
If yes, please explain allergies
Medical conditions
No medical conditions
Asthma
Diabetes
Seizure disorder
Heart condition
Other
If yes, please explain medical conditions
Medication during VBS hours
No medication needed
Daily medication
As-needed medication
Inhaler
EpiPen
Other
If yes, please explain medication needs during VBS hours
Dietary restrictions
No dietary restrictions
Vegetarian
Vegan
Gluten-free
Dairy-free
Halal
Kosher
Other
If yes, please explain dietary restrictions
Special needs or accommodations
No special accommodations
Mobility support
Hearing support
Vision support
Behavioral support
Sensory support
Other
If yes, please explain special needs or accommodations
Transportation & Dismissal
Does the child need transportation?
Yes
No
Transportation details
Authorized pickup persons (include names and phone numbers)
*
Is anyone not allowed to pick up the child?
Yes
No
Not authorized pickup details
Permissions/Consents
Photo and video permission
I give permission for my child to be photographed and/or recorded for church use
I do not give permission for my child to be photographed and/or recorded for church use
Activity participation permission
*
I give permission for my child to participate in Vacation Bible School activities
Emergency medical permission
*
I authorize emergency medical care if needed
Church & Referral Information
Does the child attend church regularly?
*
Yes
No
Church name (if applicable)
How did your family hear about Vacation Bible School?
Church bulletin
Friend or family
Social media
Church website
Flyer or poster
Community event
Other
Other source, please specify
Other concerns, instructions, or information about the child
For Church Use Only (internal)
Registration Received By
Date Received
-
Month
-
Day
Year
Date
Class/Group Assigned
T-Shirt Received
Yes
Notes
Submit Registration
Should be Empty: