VBS Registration Form

June 14th-17th | Parents/guardians registering a child for Illumination Station VBS 2026 (PreK–6th Grade).

Main

Child's Information

Name

*

Gender

*

Please select one option.

Male Female

Age

*

Medical/Allergy Information

Education

Grade

*

Please select one option.

Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Parent/Guardian

Name

*

Contact

Name

*

Phone

*

Email

*

This address will receive a confirmation email

Address

*

Mailing Address if different

Emergency Contact 1

Emergency Contact 1 Name

*

Emergency Contact 1 Number

*

Emergency Contact 2

Emergency Contact 2 Name

*

Emergency Contact 2 Number

*

Dismissal Information

Names That Are Able To Pick Child Up

*

Photography Release

May we have permission to photograph and use your child's photo from purpose of promotion?

*

Please select all that apply.

Yes No

Description

June 14th-17th

Parents/guardians registering a child for Illumination Station VBS 2026 (PreK–6th Grade).

Please Fix the Following

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