Vacation Bible School Registration

VACATION BIBLE SCHOOL

Participant Registration Form

Dates: June 15th to 18th | Time: 9am till 2:30pm | Location: 150 Cottage Lane, Kila, Mt.

PARENT/GUARDIAN INFORMATION

First Name (Required)

Last Name (Required)

Email Address (Required)

Phone Number (Required)

Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Are you a Church Member? (Required)

CHILD #1 INFORMATION

First Name (Required)

Last Name (Required)

Date of Birth (Required)

Age (Required)

Grade (Required)

Gender (Required)

T-Shirt Size (Required)

City (Required)

State (Required)

Zip Code (Required)

Allergies (Food, Medication, Environmental):

Medical Conditions (e.g., Asthma, Diabetes):

Special Needs or Accommodations:

Days Child Will Be Absent (leave blank if attending all days):

Photo/Video Release Permission: (Required)

CHILD #2 INFORMATION (Optional)

First Name

Last Name

Date of Birth

Age

Grade

Gender

T-Shirt Size

City (Required)

State

Zip Code

Allergies (Food, Medication, Environmental):

Medical Conditions (e.g., Asthma, Diabetes):

Special Needs or Accommodations:

Days Child Will Be Absent (leave blank if attending all days):

Photo/Video Release Permission:

EMERGENCY CONTACT INFORMATION

First Name (Required)

Last Name (Required)

Relationship to Child (Required)

Phone Number (Required)

Alternate Phone Number

Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Are you a Church Member? (Required)

AUTHORIZATIONS & PERMISSIONS

Medical Treatment Authorization: (Required)

In case of emergency, I authorize VBS staff to seek necessary medical treatment for my child(ren) and will assume financial responsibility.

Release & Waiver: (Required)

I release the church and VBS staff from liability for injuries or accidents that may occur during VBS activities, except in cases of negligence.

Additional Notes or Instructions: (Required)

Electronic Parent/Guardian Signature (Required)

Date (Required)

OFFICE USE ONLY

Registration ID: _________________ | Date Received: ____/____/____ | Processed By: ____/____/____

Payment Status: ☐ Paid ☐ Pending

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