Vacation Bible School Registration

Vacation Bible School Registration

Register your child for Hooked on Jesus VBS 2026, July 15–17 at 1353 Reed St., Prattville, AL.
Child's Full Name

First NameLast Name
Age
Grade (Fall 2026)
Date of Birth

MonthDayYear
Date
Parent/Guardian Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Relationship
Allergies
Medical Conditions
Special Instructions
Person Authorized to Pick Up Child 1
Person Authorized to Pick Up Child 2
Person Authorized to Pick Up Child 3
Permission to participate in Hooked on Jesus VBS activities
Permission Signature Date

MonthDayYear
Date
Photo/Video Release
Parent/Guardian Initials for Photo/Video Release
Should be Empty: