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Vacation Bible School 2025 Registration 3K - 5th Grade
If you have a child who is two years or under and you will be teaching or helping with VBS, there will be a different registration form for you to complete.
(Please see Toria Dixon or Jamie May)
*If you have more than one child to register, please complete a separate form for each child.
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* Indicates required question
1. Child's First and Last Name
*
Your answer
2. Gender
*
Male
Female
3. Child's Birthdate
*
MM
/
DD
/
YYYY
4.
Grade Child Just Completed
.
* Please select correct option so that rosters can be created accurately.
*
3 Year Old Class: Turned 3 Before 9/1/2024 (Child Must Also Be Potty Trained To Attend)
4 Year Old Class: Turned 4 Before 9/1/2024 (Child Must Also Be Potty Trained To Attend)
5 Year Old Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
5.
Name of Parent/Guardian #1 and Relationship to Child
*
Your answer
6.
Parent/Guardian #1 Phone Number
*
Your answer
7.
Name of Parent/Guardian #2 and Relationship to Child
*
Your answer
8.
Parent/Guardian #2 Phone Number
*
Your answer
9. Address
*
Your answer
10. Alternate
Emergency Contact Name and phone number
(In the event that the Parents/Guardians listed can not be reached) *Please include 3 digit area code
*
Your answer
11. Names and grade completed of any siblings also attending VBS.
Ex: Jack Smith, 4th
Your answer
12.
If coming with a family friend, please indicate family friend's name here.
Your answer
13.
Are you a member of Philadelphia Baptist Church?
Yes
No
I attend, but am not a member
Clear selection
14.
Please indicate here if there are any health concerns. (i.e. allergies, asthma, seizures, etc.)
If there are no health concerns, please type none.
*
Your answer
15.
Please indicate here if there is anything else you would like for us to know about your child so we can best meet your child's needs. (i.e. ADHD, Learning Disability, etc.)
Your answer
16.
Media Release--Do you give permission for PBC to take and include pictures of your child in social media posts, our church website, and on our VBS video for the church to view to show the wonderful memories that were made? (no names will be included)
*
Yes
No
17. How did you find out about our VBS?
School Flier
Church Bulletin / Announcements
Social Media
Signs posted outside the church, along Hwy 215 and 56
From a friend or family member
Other
Clear selection
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