2025 VBS Child Registration Form

July 14-17, 2025 | Please fill out this form and click submit.

Child # 1 Information

First Name

*

Last Name

*

Date of Birth

*

Gender

Please select all that apply.

Male Female

Grade Completed

*

Please select one option.

Prek 3 (as of 9/1/24 & Potty Trained) Prek4 Kindergarten 1st 2nd 3rd 4th 5th

Child #2 Information

First Name

Last Name

*

Date of Birth

Gender

Please select one option.

Male Female

Grade Completed

Please select one option.

Prek 3 (as of 9/1/24 & Potty Trained) Prek 4 Kindergarten 1st 2nd 3rd 4th 5th

Child #3 Information

First Name

Last Name

*

Date of Birth

Gender

Please select one option.

Male Female

Grade Completed

Please select one option.

Prek 3 (as of 9/1/24 & Potty Trained) Prek4 Kindergarten 1st 2nd 3rd 4th 5th

Child #4 Information

First Name

Last Name

*

Date of Birth

Gender

Please select one option.

Male Female

Grade Completed

Please select one option.

Prek 3 (as of 9/1/24 & Potty Trained) Prek4 Kindergarten 1st 2nd 3rd 4th 5th

Parent Information

Name

*

Address

*

Phone

*

Email

*

This address will receive a confirmation email

Church You Attend:

Emergency Contact

Name

*

Phone

*

Relationship to Child(ren)

*

In Case of Emergency

Physicians Name

*

Physicians Phone

*

Preferred Hospital:

*

Hospital Address

*

Health & Food Concerns

Food Allergies

*

Please select all that apply.

Yes No

List of Allergies (please specify which child(ren)).

Medical Treatment/Special Needs:

Pick-up information

Name

*

Phone

*

Relationship to Child

*

Please select one option.

Mother Father Guardian Grandparent Other

Releases / Permissions

Permission to photograph my child(ren) and use it for the purpose of promotion

*

Please select all that apply.

Yes No

Please review our release information by clicking this Link

Authorization to Participate

*

Please select all that apply.

Yes No

Authorization for Treatment

*

Please select all that apply.

Yes No

Comments

Description

July 14-17, 2025

Please fill out this form and click submit.

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