VBS Registration Form

VBS Child Registration

VBS is for kids 5 years through 6th-grade grads.

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

Gender

Grade Entering Fall 2025

Birthday

Would you like to purchase a T-shirt for $10?

Yes

No

T-shirt Size

Who referred you to our VBS?

Emergency Contact 1

Emergency Contact Phone Number

Emergency Contact 2

Emergency Contact Phone Number

Medical Notes

Parent/Guardian Signature

Signature

Parent/Guardian Name

First Name

Last Name

Date Completed