The Garden Worship and Outreach Center
Vacation Bible School
August 3rd – August 7th, 2026
6:00 pm – 8:00 pm
STUDENT REGISTRATION FORM
Director Contact: Pastor T. Brown @ thegardenwoc.org or 336-706-7418
(Please Print)
Child's Name
Child's Age
Child's Birth Date
Child's Grade
Parent/Guardian Name(s)
Home Phone:
Format: (000) 000-0000.
Mobile Phone:
Format: (000) 000-0000.
Email:
example@example.com
Preferred Contact Method:
EMERGENCY INFORMATION
Emergency Contact 1:
Phone:
Format: (000) 000-0000.
Emergency Contact 2:
Phone:
Format: (000) 000-0000.
Allergies or Special Needs
DISMISSAL
Who may pick up your child at the end of each VBS day?
Name
Relationship
Name
Relationship
Parent/Guardian Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
The Garden WOC • 460 Salem Church Rd. • Reidsville, NC • (336) 706-7418•
thegardenwoc.org
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