Illumination Station - VBS 2026
Please fill out this form and click submit.
Child first & last name
*
Child's birthday
*
Child's completed grade
*
Parent(s)/Guardian(s) first &last name
*
Parents Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Allergies or Medical information needed to know?
*
Emergency contact name and relationship
*
Emergency phone
*
Dismissal Information - who may pick up your child from VBS each night?
*
Do you or your child attend Sunday School and/or Church anywhere? If so, where?
*
Do we have permission to photograph your child?
*
Please select one option.
Yes
No
Do we have permission to use your child's photograph for the purpose of promotion and/or advertisement for church publications such as bulletins, PowerPoints, our public church website and our public church Facebook page?
*
Please select one option.
Yes
No
Has your child participate in VBS with us before?
*
Please select one option.
Yes
No
Date:
*
Submit
Description
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