VBS REGISTRATION 2026
Please complete a seperate registration form for each child.
CHILD INFORMATION
First & Last Name:
First Name
Last Name
Birthdate (Year, Month & Day):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade (as of September 2026):
Mailing Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
MEDICAL INFORMATION
Does your child have any allergies?
Yes
No
If yes, please list:
Is your child bringing any medications?
Yes
No
If yes, please specify:
Does your child have any medical conditions we should be aware of?
Does your child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of?
Yes
No
If yes, please explain:
Primary Physician Name:
Phone Number:
Format: (000) 000-0000.
MCP:
OTHER INFORMATION
Is there another child they would like to be grouped with if possible?
Parent/Guardian Initials:
Continued on next page.
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GALAXY VBS REGISTRATION
Page 2
PARENT/GUARDIAN INFORMATION
Parent/Guardian First & Last Name:
Relationship to Child:
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Alternate Name & Phone Number:
EMERGENCY CONTACT INFORMATION (OTHER THAN GUARDIAN)
Emergency Contact Name:
Relationship to Child:
Phone Number:
Format: (000) 000-0000.
PHOTO RELEASE
Do you grant permission for your child to be photographed ONLY for VBS purposes. It will be used to recap the evening and a slideshow will be shown during our Sunday Morning Celebration.
Do you grant permission for your child to be photographed ONLY for VBS purposes. It will be used to recap the evening and a slideshow will be shown during our Sunday Morning Celebration.
Yes
No
AUTHORIZATION & CONSENT
The safety of your child is our primary concern. Precautions will be taken for their wellbeing and protection.
I/we, the Parents or guardians, authorize the leader or one of the staff at Bethel Pentecostal Tabernacle (PAONL) to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.
I/we, named below, undertake and agree to indemnify and hold harmless Program Personnel, Bethel Pentecostal Tabernacle (PAONL), and its Leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of this church, as well as of any medical treatment authorized by the supervising individuals representing this Church/ Pentecostal Assemblies of Newfoundland and Labrador. This consent and authorization is effective only when participating in or traveling to events sponsored by Bethel Pentecostal Tabernacle (PAONL).
I have read, understood and agree with the above.
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Signature:
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