VBS 2025 Family Registration Form

Parent / Guardian Name(s):

Email Address

This address will receive a confirmation email

Mobile Number

Secondary Phone Number

Address

Preferred Method Of Communication:

Text Email Phone Call

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

Emergency Contact #1 Name:

Emergency Contact #1 Phone:

Emergency Contact #1 Relationship To Child:

Emergency Contact #2 Name:

Emergency Contact #2 Phone:

Emergency Contact #2 Relationship To Child:

Permission To Check-in / Check-Out (In Addition To Parents - MUST Be At Least 16 Years Old):

Permission For Photos / Videos - Printed, Social Media And / Or Website (Please See Amanda Geiman For Permission Details.):

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 and warrant that I am the minor’s parent or legal guardian.):

Date Of E-Signature:

Child #1

Name:

Gender:

Male Female

Date of Birth:

Grade As Of September 2024:

School:

Allergies:

Child Carries An Inhaler:

Yes No

Child Carries An Auto-Injector:

Yes No

Special Needs Or Concerns:

Child #2

Name:

Gender: Male Female

Date of Birth:

Grade As Of September 2024:

School:

Allergies:

Child Carries An Inhaler: Yes No

Child Carries An Auto-Injector: Yes No

Special Needs Or Concerns:

Child #3

Name:

Gender: Male Female

Date Of Birth:

Grade As Of September 2024:

School:

Allergies:

Child Carries An Inhaler: Yes No

Child Carries An Auto-Injector: Yes No

Special Needs Or Concerns:

Child #4

Name:

Gender: Male Female

Date Of Birth:

Grade As Of September 2024:

School:

Allergies:

Child Carries An Inhaler: Yes No

Child Carries An Auto-Injector: Yes No

Special Needs Or Concerns:

Description

VBS 2025 FAMILY REGISTRATION FORM

VBS Check-in begins each evening at 5:45 in the Chapel lobby.

When you have completed the registration form for your child(ren), be sure to scroll to the bottom and click on the "Submit" button and wait for the confirmation message. Closing the window before receiving the confirmation may void your registration.

Thank You!

VBS 2025 Family Registration Form

Description

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