VBS Registration VBS Registration June 23-26, 2025 | 5:30 - 7:30 pm Child's Name* First Last Upcoming Grade*K4K51st2nd3rd4th5thChild's Age*UntitledFirst ChoiceSecond ChoiceThird ChoiceChild's Birthdate*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender* Male Female Do you have additional children to register?* Yes No Any allergies?* Yes No List Child's Name* First Last Upcoming GradeK4K51st2nd3rd4th5thChild's AgeChild's BirthdateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender Male Female List Child's Name First Last Upcoming GradeK4K51st2nd3rd4th5thChild's AgeChild's BirthdateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender Male Female Child's Name First Last Upcoming GradeK4K51st2nd3rd4th5thChild's AgeChild's BirthdateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender Male Female Parent / Guardian's Name* First Last Email* Phone*Emergency Contact Name & Phone Number*Media Consent I hereby consent to the use of photographs/video footage of my children for publicity purpose. Medical Release* In case of a medical emergency, I hereby give my permission to the physician selected by the Vacation Bible School director to secure proper treatment and/or hospitalization for my children Signature of Parent / Guardian*By typing your name below you are digitally signing and indicating agreement with the releases above. You understand that digitally signing this agreement has the same effect as physically signing a paper original. Δ
