VBS Registration 2026

Please fill out this form and click submit.

Child's Name

*

Gender

*

Please select one option.

Male Female

Parent's Name(s)

*

Parent's Cell Phone

*

Address

*

Parent's Work or other number

*

Parent's Email

*

This address will receive a confirmation email

Child's Birthdate

*

Last Grade Completed

*

Please select one option.

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

Allergies, Medical & Special Needs

*

Emergency Contact #1 Name

*

Emergency Contact #1 Phone

*

Emergency Contact #2 Name

*

Emergency Contact #2 Phone

*

Authorized Pick-up Person #1 Name (and phone number if not already listed)

*

Authorized Pick-up Person #2 Name (and phone number if not already listed)

*

Authorized Pick-up Person #3 Name (and phone number 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 photograph to appear on church's Facebook page?

*

Please select one option.

Yes No

Description

Please fill out this form and click submit.

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