VBS "illumination Station" Registration Form 2026

Welcome to Illumination Station VBS!
Theme: Jesus: The Light of the World

Get ready for an exciting week of Bible adventures, worship, games, crafts, outdoor activities, snacks, and unforgettable fun as we discover who Jesus really is!

Throughout the week, children will explore Jesus' question:

"Who do you say that I am?" (Matthew 16:15)

Through engaging lessons and hands-on activities, kids will discover that Jesus isn't just a good teacher or someone from history—He is the Light of the World who brings hope, truth, forgiveness, and eternal life.

Our prayer is that every child will grow in their faith, build lasting friendships, and leave knowing that they can shine the light of Jesus wherever they go.

"I am the light of the world. Anyone who follows me will never walk in the darkness but will have the light of life."
John 8:12

Register below

Child 1

First NameLast Name

Birth Date

Date

Gender

Age

Grade

T-Shirt Size

Youth size include "Y" + size. (Ex: Y-M)

Child 2

First NameLast Name

Birth Date

Date

Gender

Age

Grade

T-Shirt Size

Youth size include "Y" + size. (Ex: Y-M)

Child 3

First NameLast Name

Birth Date

Date

Gender

Age

Grade

T-Shirt Size

Youth size include "Y" + size. (Ex: Y-M)

Additional Child Fill here:

ATTENDANCE

Will your child attend all 5 days (Aug 3 - Aug 7)?

If not, please select which days your child will attend: (Checkboxes)

PARENT OR GUARDIAN INFORMATION

Parent/Guardian Name

First NameLast Name

Primary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Secondary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

EMERGENCY CONTACT
In the event that I cannot be reached during an emergency, I give permission for the VBS staff to contact the person listed below, who is authorized to make decisions on behalf of my child.

Emergency Contact Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to child

Medical Information

Please list all allergies -- or type "none" if there are none

Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)

Anything you'd like us to know about your child?

RULES & REGULATIONS

Vacation Bible School – Rules & Regulations Agreement
Church By the Side of the Road | August 3–7, 2026 | 10:00 AM – 2:00 PM

VBS Rules & Expectations:

*All students must follow VBS rules and staff directions.
*Students may not leave the church campus without permission from VBS staff.
*Students will be held responsible for damage to property.
*No visitors or guests allowed unless approved in writing beforehand.

Medical & Liability Release:

I, the undersigned parent/guardian, give permission for my child to participate in Vacation Bible School hosted by Church By the Side of the Road. I waive any liability against the church or its representatives in the case of injury or emergency.

In case of emergency, if I cannot be reached, I authorize the church, Director of Children's Ministry; Blessing Scott, to make medical decisions for my child.

Student Medication:

If your child takes medication, please send it in a clear, labeled bag with instructions. All medication must be turned in upon arrival.

Final Disclaimer:

I hereby release Church By the Side of the Road, its staff, and volunteers from any claims of injury, illness, or damages before, during, or after participation in this event.

Checkbox for Agreement

Photo/Video Release
Church By the Side of the Road occasionally takes photos and videos during Vacation Bible School to capture special moments for internal use, recaps, promotional materials, church slideshows, and social media.

VBS Registration Fee & Payment Options:

A non-refundable registration fee of $25 per child is required to secure your spot. This fee covers all five days of VBS, snacks, crafts, tshirt, supplies and materials.

For families registering multiple children, use promo code JESUS! to receive a $5 discount.

If you are in need of financial assistance, please email Blessing Scott at (blessing@cbsr.org) for scholarship options.

Your registration is not complete until payment is received.
For questions, contact Blessing Scott at 808-953-9312.

VBS Registration Payment:

VBS Registration Fee

illumination Station "Shining a light on who Jesus really is"

$25.00 Quantity

Enter coupon

Total

Please submit payment using one of the following options:

By submitting this form, I ackowledge I have read and understand the above information.

Parent/Guardian Signature:

CBSR VBS Registration Form 2026

Medical Information

RULES & REGULATIONS

VBS Registration Payment: