VBS Student Registration Form

Student Name

Address

School Grade (Fall 2025)

1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

PARENT/GUARDIAN INFORMATION

Parent/Guardian

Phone

This address will receive a confirmation email

EMERGENCY INFORMATION

Emergency Contact 1:

Phone

Emergency Contact 2:

Phone

Besides the names listed above, who may pick up your child after the VBS ends each day?

Name

Relationship:

ALLERGIES/SPECIAL NEEDS:

May we have permission to photograph your child and post on our website?

Yes No

Description

Please fill out this form and click submit.