VBS 2026 Family Registration Form

Parent / Guardian Name(s):

Address:

Cell Phone Number:

Secondary Phone Number:

Email:

This address will receive a confirmation email

Emergency Contacts (in the event we are not able to reach you).

Emergency Contact Name:

Emergency Contact Phone Number:

Emergency Contact Relationship To Child:

Permission To Check-In / Check - Out (In addition to parents - MUST Be At Least 18 Years Old):

I give permission for photos / video to be used internally only (photo displays, slideshows, etc.)

Yes No

I give permission for photos/video to be used publicly (church & social media):

Yes No

Parent / Guardian E-Signature (By signing this document electronically, I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. I represent that I am the minor's parents or legal guardian):

Date Of E-Signature:

Child 1:

Name:

Gender:

Male Female

Birthdate: (month/day/year)

Grade As Of September 2025: