VBS Registration Form 2026
Bybee's Road Baptist Church
4989 Bybee Church Road
Troy VA  22974
(434) 589-2824

Vacation Bible School
ILLUMINATION STATION
Shining a Light on Who Jesus Realy Is
June 17-19, 2026
6:00-8:30pm

On-site registration begins at 5:00pm each evening with food provided.
VBS activities begin at 6:00pm each evening.
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Illumination Station - John 8:12
Child's Name *
Child's Nickname
Child's Gender *
Child's Grade Entering and School *
Child's Home Church
Child's Allergies / Medical Conditions / Special Needs *
Parent Name *
Address *
Parent Phone Number(s) *
Parent E-Mail
Emergency Contact Person *
Emergency Contact Person Phone Number(s) *
Alternate Pickup Person Name(s)
Alternate Pickup Person Phone Number(s)

PHOTOGRAPH RELEASE STATEMENT

I give permission for my child to be photographed, and their image may be used in church publications, including on our website and social media platform(s), for the purpose of promotion.

 *
MEDICAL RELEASE STATEMENT

I, the undersigned parent or legal guardian of the child named above, hereby give permission for my child to participate in all activities associated with Vacation Bible School.  In the event of an emergency, I authorize the VBS staff, volunteers, or designated representatives to secure and consent to any necessary medical treatment for my child deemed necessary by a licensed medical professional.

I understand that every reasonable effort will be made to contact me before such action is taken.  I agree to assume all costs related to such treatment and release the church, its staff, and volunteers from any liability in connection with medical care provided.

BY PROVIDING MY NAME BELOW, I GIVE CONSENT TO THIS MEDICAL RELEASE.
 *
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