2026 VBS Registration Form
Please complete this Vacation Bible School waiver for your child to participate in the Cornerstone Bible Church (CBC) VBS Program for the dates July 26th-30th, meal at 5:30pm, program 6:00pm-8:00pm. Ages 4 through 6th grade are welcome. Located at 1721 Lake Ave., Gothenburg, NE
Participant Name
*
First Name
Last Name
Participant Age
*
Grade going into for Fall 2026
Please Select
PreK
Kindergarten
1st
2nd
3rd
4th
5th
6th
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please list any allergies or medical conditions
Do you have a church that you usually attend? Let us know which one
I authorize the VBS staff to seek emergency medical treatment for my child if necessary.
*
Yes
No
I consent to my child's participation in the VBS program.
*
Yes
No
I give consent for CBC to publish pictures of my child on any of CBC's social media platforms / communications.
*
Yes
No
By signing this form, I agree to release and hold harmless the CBC staff and volunteers from any claims or liability arising from my child's participation.
*
Submit
Submit
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