Vacation Bible School Registration 2026

Vacation Bible School Registration

Complete the required student and emergency contact details, and confirm photo/video permission.
Student Information
First Name
Last Name
Birth Date

MonthDayYear
Date
Gender
Grade Level Completed
Home Church (if any)
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
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.
Siblings Enrolled in VBS
Name
Name
Name
Name
Emergency Contacts
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian First Name
Primary Guardian Last Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Alternate Emergency Contact First Name
Last Name
Relationship to Child
Medical Information
Allergies (Please list all allergies -- or type N/A if there are none)
Does the 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)
Medical concerns (Please list all medical concerns -- or type N/A if there are none)
Additional Information and Consent
Please list the names of any other children (friends or family) that you would like placed in the same class as this child
VBS photos/videos are taken for promotional purposes related to Reflection Ministries and Vacation Bible School. These pictures appear in various media outlets such as our Facebook, instagram, and webpage.
By submitting this form, I ackowledge I have read and understand the above information.
Signature
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Vacation Bible School Registration

Student Information

Emergency Contacts

Medical Information

Additional Information and Consent