2026 VBS

Registrant First Name

Registrant Last Name

Registrant's Address

Street Address

Street Address 2

City

State

ZIP

Mobile Phone

Home Phone

Work Phone

Email:

Select Class

Age Of Student (For Youth Class Only)

Medical or Other Information we need to be made aware of (Please include Food Allergies, etc.)

Youth Registrant's Parent or Guardian (REQUIRED)

First Name

Last Name

Parent/Guardian Mobile Phone (If different from above)

Parent/Guardian Home Phone (If different from above)

Emergency Contact Name (Other than Parent/Guardian)

First Name

Last Name

Emergency Contact Phone

Dismissal Information - Name of Other Individual Permitted to Pick Up Your Child (ID required at pick up)

First Name

Last Name

Does Your Child Currently Attend Church? (Select One)

If so, where?

Is your child a guest of a church member? (Select One)

If so, who are they a guest of?

May we have permission to photograph your child? (Select One)

May we have permission to photograph your child for promotional purposes? (Select One)