VBS 2026- Ilumination Station!

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July 19th- July 23rd
6pm-9pm
Ages 4 years old- 12th Grade

Please make sure you complete this form for each child you are registering. Thank you!

For VBS Participation

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Please select all that apply.

July 2026

Child's Information

First Name

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Birthdate

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What grade did your child just complete?

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Pre-k 4 Kinder 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Address

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Phone

Parent/Guardian Information

First Name

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Last Name

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Phone

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Alternate Phone

Email

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This address will receive a confirmation email

Emergency Contact Information

Emergency Contact Name

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Relationship to Child

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Mother Father Grandparent Guardian Aunt Uncle Sibiling Babysitter/Nanny Other

Phone Number

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Is there any person not listed that is allowed to pick up your child from VBS?

Does your child have any allergies?

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Yes No

If yes, allergic to:

Does your child have a chronic illness or medical condition?

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Yes No

If yes, what chronic illness or medical condition:

Does your child attend Sunday School? If so Where?

May we have permission to photograph your child?

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Photos Okay No Photos

May we have permission to use your child's photograph for the purpose of promoting on our website or future events?

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Yes No

By checking this box, I am indicating that the above information is accurate

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Yes

Electronic Signature

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By entering may name in the box above, I am providing my digital signature on this form

Description

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