Vacation Bible School Registration form

Adult / Primary Contact

First Name

Last Name

Phone Number

Address (Optional)

Apt / Unit # (Optional)

Note: If your child is unable to attend the closing ceremony, their certificate will be mailed to them

ADDITIONAL ADULT

TOTAL # Of Adults Attending

Adult #2 First Name

Adult #2 Last Name

Attending VBS with another adult? Select "2"

FRUIT FULL FARMERS (STUDENTS):

Of YOUTH students Attending

Farmer #1

First Name

Last Name

Age

Grade Entering This Fall

ALLERGIES

I grant permission for photos of this attendee to be used for VBS and church promotional purposes.

Farmer #2

First Name

Last Name

Age

Grade Entering This Fall

ALLERGIES

I grant permission for photos of this attendee to be used for VBS and church promotional purposes.

Farmer #3

First Name

Last Name

Age

Grade Entering This Fall

ALLERGIES

I grant permission for photos of this attendee to be used for VBS and church promotional purposes.

Farmer #4

First Name

Last Name

Age

Grade Entering This Fall

ALLERGIES

I grant permission for photos of this attendee to be used for VBS and church promotional purposes.

Farmer #5

First Name

Last Name

Age

Grade Entering This Fall

ALLERGIES

I grant permission for photos of this attendee to be used for VBS and church promotional purposes.

EMERGENCY CONTACT

Same as Primary Contact

Emergency Contact Name

Phone Number

Relationship to Student(s)

OTHER INFORMATION:

Ex: special needs, medical, dietary, "teacher tips", etc.

I certify that the information provided is accurate and that I am authorized to register all attendees listed on this form.

Please certify that the information provided is accurate.

Thank you! Your registration has been submitted successfully.

Please complete all required fields highlighted above.