VBS 2025 Registration

Please fill out this form and click submit.

Participants Name

*

Gender

*

Please select one option.

Male Female

Parent's Name(s)

*

Parents Cell Phone

*

Address

*

Parents Work or other number

Parent's Email

*

This address will receive a confirmation email

Child's Birthdate

*

Last Grade/age completed

*

Please select all that apply.

3year old 4 year old 5 year old Kindergarten 1st 2nd 3rd 4th 5th 6th

Allergies, Medical & Special Needs

*

Emergency Contact #1 Name

*

Emergency Contact #1 Phone Number

*

Emergency Contact #2 Name

*

Emergency Contact #2 Phone Number

*

Authorized Pickup Person #1 Name (and Phone if not already listed)

*

Authorized Pickup Person #2 (and phone if not already listed)

*

Authorized Pickup Person #3 (and phone if not already listed)

*

Do you attend church regularly?

*

Please select one option.

Yes No Sometimes

If yes, where?

*

Permission to photograph your child for crafts or other VBS needs?

*

Please select one option.

Yes No

Permission for child's photo to appear on church Facebook page?

*

Please select one option.

Yes No

Description

Please fill out this form and click submit.

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