VBS Registration Date of VBS: June 8-12

VBS Registration Date of VBS: June 8-12
Name of Child

First NameLast Name
Date of Birth

MonthDayYear
Date
Grade Child Last Completed as of May, 2025
List Any Allergies or Special Information
Names of Additional Children Attending
For Children's Craft Purposes, please choose your child's t-shirt size:
Please complete a form for each of your children attending. However, if you completed the “names of additional children attending” portion above, you may skip the rest of the registration form for children in your immediate family as long as your answers will be the same for each child. If a child is attending with you and is not in your immediate family, please complete an additional registration form and answer each portion.
Name of Parent or Guardian

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone

Area CodePhone Number
2nd Phone

Area CodePhone Number
Email
example@example.com
Name of Emergency Contact

First NameLast Name
Emergency Contact Phone

Area CodePhone Number
Emergency Contact Relationship to Child
Child Will Be Picked Up By
May We Photograph Your Child? (for crafts, promotional purposes, Facebook)
Are You a Member or Regularly Attend a Local Church?
Please Share With Us the Name of Your Church:
Should be Empty: