Illumination Station VBS @ Collide
Event Timing: June 1-5, 2026
Event Address: Highland Baptist Church, 2201 N. Main St., Clovis, NM
Contact us at (575) 763-7942 or collide@highlandclovis.com
Only ONE CHILD per form entry, please.
To be filled out by Parent/Guardian.
Event open to children completing Pre-K (Must be potty-trained) through 6th Grade.
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Child's First Name *
Child's Last Name *
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Address (#, Street, City, State, Zip) *
Mailing Address (If Different)
Main Phone Number (Numbers Only) *
Secondary Phone Number
Email Address
AGE INFORMATION
Birth Date of Child *
MM
/
DD
/
YYYY
Last Grade in School (Completing 2025) *
MEDICAL INFORMATION
Allergies (Food, Medicine, etc.)
Does your child have any special needs or concerns that we need to be aware of? If yes, please give as much detail as you can.
EMERGENCY CONTACTS
Emergency Contact #1: Name *
Emergency Contact #1: Phone Number (Numbers Only) *
Emergency Contact #2: Name
Emergency Contact #2: Phone Number (Numbers Only)
Names of people allowed to pick up your child at the end of the night (especially if there is carpooling): *
CHURCH INFORMATION
Does your child attend Sunday School somewhere else?
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If "Yes", where do they attend?
If your child is visiting our church, who is he/she the guest of?
PHOTOGRAPHY NOTICE
Please be aware that by registering for our Vacation Bible School and signing below, you are giving Highland permission to photograph your child participating in the event and to use these photographs for the purpose of church promotion inside the church and online.
Please check the following to confirm your agreement: *
Required
Please write your name representing your online signature. *
Submit
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