VBS 2026

Child's Name

Child's Age

Child's DOB

Child's Grade

Parent/Guardian Name:

Phone

Address

This address will receive a confirmation email

Preferred Contact Method:

Phone Email

EMERGENCY INFORMATION

Emergency Contact #1

Phone

Emergency Contact #2

Phone

Doctor

Phone

Allergies/Special Needs:

Dismissal (Who may pick up your child at the end of each VBS Day?)

Name

Relationship:

Name

Relationship:

Photos/Videos (may we use pictures/videos taken of your Child during VBS on post on our Website/Facebook)?

Yes or No

Yes No

By typing your name below this will act as a digital signature:

Description

Please fill out this form and click submit.