Lighthouse Niagara VBS Registration Form 2025

VBS Registration Form 2026

(Please complete One Per Child)
Aug 24-28, 9:30 am to 12 noon

Ages 5 - 12
Child's Name

First NameLast Name
Child's Gender
Age (now)
Date of Birth

MonthDayYear
Grade Completed this June
Parent/Guardian Information
Parent / Guardian's Name

First NameLast Name
Relationship to Child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
Home Church (if any)
Emergency Information
Emergency Contact Name #1

First NameLast Name
Emergency Contact Phone Number #1
Format: (000) 000-0000.
Relationship to child
Emergency Contact Name #2

First NameLast Name
Emergency Contact Phone Number #2
Format: (000) 000-0000.
Relationship to child
Food Allergies or other Medical Conditions
Medical Waiver
All reasonable precautions for the safety and health of the participants will be taken. He/She will be properly supervised in activities.

In the event of accidents or sickness, Lighthouse Church of God, its staff and volunteers are released from any liability. In the event of injury requiring medical attention, I authorize treatment for the participant and understand that reasonable attempts will be made to contact the listed emergency contacts above, should such a situation occur.

The participant must be covered by provincial health insurance or equivalent medical coverage.
Dismissal

Please pick up your child promptly at 12 noon each day of VBS.
My child has permission to walk home by themself
Name of adult who may pick up my child

First NameLast Name
Name of adult who may pick up my child

First NameLast Name
Name of adult who may pick up my child

First NameLast Name
Name of adult who may pick up my child

First NameLast Name
Photos/Video
VBS photos/videos are taken for promotional purposes related to Lighthouse Niagara and Vacation Bible School. These pictures appear within the church only (NOT on social media).
Do you allow your child to be included in these photos/videos?
If no, do you allow your child to be included in a group photo only that will be part of the Friday craft your child will bring home?
Other Information
Please email me when there are any special children's programs
I waive any responsibility to all staff and volunteers for any lost or damaged items that my child may bring with them.
Comments and/or Questions
Today's Date

MonthDayYear
Parent/Guardian Signature

First NameLast Name
NOTE: Original signature is required first day of attendance.
--- NOTE: A reminder email will be sent out approximately 1 week prior to start date. ---
Should be Empty:

VBS Registration Form 2026

Aug 24-28, 9:30 am to 12 noon

Parent/Guardian Information

Emergency Information

Medical Waiver

Dismissal

Photos/Video

Other Information