Vacation Bible School Registration

Vacation Bible School Registration

Enter your details, add up to four children, and complete the required permissions and authorizations.
Parent or Guardian Information
Parent or Guardian Name

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child or Children Information
Child 1 Full Name

First NameMiddle NameLast Name
Child 1 Preferred Name (if different)
Child 1 Date of Birth

MonthDayYear
Date
Child 1 Medical Information (allergies, medications, medical conditions, other)
Child 1 Support Information (learning, accessibility, behavioural, sensory, other)
Child 2 Full Name

First NameMiddle NameLast Name
Child 2 Preferred Name (if different)
Child 2 Date of Birth

MonthDayYear
Date
Child 2 Medical Information (allergies, medications, medical conditions, other)
Child 2 Support Information (learning, accessibility, behavioural, sensory, other)
Child 3 Full Name

First NameMiddle NameLast Name
Child 3 Preferred Name (if different)
Child 3 Date of Birth

MonthDayYear
Date
Child 3 Medical Information (allergies, medications, medical conditions, other)
Child 3 Support Information (learning, accessibility, behavioural, sensory, other)
Child 4 Full Name

First NameMiddle NameLast Name
Child 4 Preferred Name (if different)
Child 4 Date of Birth

MonthDayYear
Date
Child 4 Medical Information (allergies, medications, medical conditions, other)
Child 4 Support Information (learning, accessibility, behavioural, sensory, other)
Permissions and Authorizations
All permissions and authorizations in this section apply to all children included in this registration.
Names of all people permitted to pick up the children
Parent or Guardian Acknowledgement
Parent or guardian electronic signature
Date

MonthDayYear
Date
Should be Empty:

Vacation Bible School Registration

Parent or Guardian Information

Child or Children Information

Permissions and Authorizations