VBS 2026 - Child Registration Form

Please fill out this form separately for each child in your family.

To help us plan, please register your child by July 6th.

Child Info

Name

Address

Date of Birth

(MM/DD/YYYY)

Grade

Please choose the grade your child will be in during the '25-'26 school year.

Gender

Pronouns

If you chose Other, please share your child's pronouns

Does your child have any food allergies? If so, please list.

We often serve a snack during our programming. Do you consent to us providing your child with a snack, keeping in mind that we will provide an alternative for any known allergies.

Yes No

Are there any behavioral or medical conditions we should be aware of? If so, please list.

Primary Parent/Guardian Contact Info

Parent/Guardian's Name

This address will receive a confirmation email

Cell Phone

Home Phone

Work Phone

Event Info

Which days do you estimate you will be attending VBS? (Check all that apply.) All week Monday, July 20 Tuesday, July 21 Wednesday, July 22 Thursday, July 23

Can you or another grown-up in your family help as a volunteer? Yes, count me in. Maybe, contact me as it gets closer. No, I can't help this time.

We will plan to serve dinner each night from 5-6 pm before VBS. What are the chances your family would attend dinner? (This isn't a commitment, but it will help us plan for numbers.) Very Likely Likely Unlikely

If you plan to attend dinner, how many people in your family will likely eat?

How did you hear about our VBS?

I'm a member of Bethlehem I'm a member of Centenary I'm a member of First Presbyterian I'm a member of First Congregational UCC Facebook Mailing Friend or family member

Permissions

I give permission for my child to attend Vacation Bible School, taking part in the normal program activities. This may include walking in a group to and from either church building. I authorize Bethlehem Lutheran Church, Centenary United Methodist Church, First Presbyterian, or First Congregational UCC to secure a doctor to provide any necessary emergency medical care. I also give permission for the use of photographs, video, and electronic images including my child in church promotion.

I agree (Checking agree acts as a signature)

Bounce House Waiver: If you choose

I agree. (Checking agree acts as a signature) I do not agree. By checking this, you are choosing not to have your child participate in a VBS activity using a bounce house. (Checking I do not agree acts as a signature)

Dear Parent/Legal Guardian: By participating in programs, services, and activities of Bethlehem Lutheran Church, Centenary United Methodist Church, First Presbyterian, and First Congregational UCC, you agree to the following: On behalf of yourself and your children, you hereby release, covenant not to sue, discharge, and hold harmless Bethlehem, Centenary, First Presbyterian, and First UCC, their employees, agents, and representatives, of and from all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to your participation in our programs, services or activities. You understand and agree that this release includes any claims based on the actions, omissions, or negligence of this organization, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any hosted or programmed event.

I agree (Checking agree acts as a signature)

Questions or Comments

Any questions or comments? Or, is there anything that would be helpful for us to know?

VBS 2026 - Child Registration Form

Description

Please Fix the Following