VBS Registration Date of VBS: June 8-12
Name of Child (one form per child please)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade Child Last Completed as of May, 2026
Completed K-4
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
List Any Allergies or Special Information
For Children's Craft Purposes, please choose your child's t-shirt size:
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Name of Parent or Guardian
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
-
Area Code
Phone Number
Name of Emergency Contact
First Name
Last Name
Emergency Contact Phone
-
Area Code
Phone Number
Emergency Contact Relationship to Child
Mother
Father
Grandparents
Other
Child Will Be Picked Up By
Mother
Father
Grandparent
Other
May We Photograph Your Child? (for crafts, promotional purposes, Facebook)
Yes
No
Are You a Member or Regularly Attend a Local Church?
Yes
No
Please Share With Us the Name of Your Church:
Submit
Should be Empty: