Vacation Bible School 2025 Registration

Please fill out this form and click submit.

Parent and Emergency Contact Information

Parent/Guardian First and Last Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Name of Secondary Emergency Contact

Secondary Contact's Relationship to Child

Secondary Contact's Emergency Phone

Name(s) of other individuals authorized to pick-up child

Do you want your child(ren) released to walk home by themselves after the event?

*

Please select one option.

Yes No

Register Your Child(ren)

Child # 1 - First and Last Name

*

Child # 1 - Birthdate

*

Child # 1 - Last grade completed

*

Please select one option.

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

Child #1 - Gender

*

Please select one option.

Male Female

Child # 1 - allergies/medical info

Child # 2 - First and Last Name

Child # 2 - Birthdate

Child # 2 - Last grade completed

Please select one option.

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

Child #2 - Gender

Please select one option.

Male Female

Child # 2 - allergies/medical info

Child # 3 - First and Last Name

Child # 3 - Birthdate

Child # 3 - Last grade completed

Please select one option.

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

Child #3 - Gender

Please select one option.

Male Female

Child # 3 - allergies/medical info

Child # 4 - First and Last Name

Child # 4 - Birthdate

Child # 4 - Last grade completed

Please select one option.

Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6

Child #4 - Gender

Please select one option.

Male Female Option

Child # 4 - allergies/medical info

Description

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