2026 Vacation Bible School Registration Form

"*" indicates required fields

Child's Name*

First Last

Birth Date*

Child's gender*

Male

Female

Grade (2026 – 2027 school year)*

Parent Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Parent Phone*

Alternate Phone

Parent Email*

Emergency Contact Name*

First Last

Relation to student*

Emergency Contact Phone*

Please write the name and phone number of all who may pick up your child at the end of the day*

Please include any medical and/or food allergies*

May we have permission to photograph your child?*

Yes

May we have permission to use your child's photograph for the purpose of promotion?*

Yes