Illumination Station - VBS 2026
Illumination Station VBS 2026
June 15-June 19, 2026
6:00pm-8:30pm
New Life Baptist Church, Davie, FL
2400 S Pine Island Rd., Davie, FL, 33324

PLEASE NOTE: Illumination Station VBS is open to children who are ages 4-12 years old as of June 15, 2026

Please call 954-423-3933 if you have any questions or need assistance with this form.
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Parent or Guardian's First & Last Name *
Parent or Guardian's Cell Phone *
Format 123-456-7890
Spouse's First & Last Name
Spouse's Cell Phone
Format 123-456-7890
Home Address *
Example: 12345 Avondale Street, Davie, FL 33324
Email Address *
Emergency Contact (if different from parent or guardian)
Emergency Contact Phone Number
Format 123-456-7890
Authorized to Pick Up Child *
Please list any individuals authorized to pick up your children, including yourself and your spouse (if applicable).
How did you hear about Illumination Station Vacation Bible School? *
Please check all that apply.
Required
First Child's Information
Child's First Name *
Child's Last Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Please list any food allergies or medical conditions where immediate medical attention may be needed. *
For example, Peanut allergy, type-1 diabetes, allergic to grass, etc.
Please list any non-emergency food sensitivities or dietary preferences  (i.e., Red dye 40, gluten or dairy allergy, etc.) *
Second Child's Information
Child's First Name
Child's Last Name
Child's Date of Birth
MM
/
DD
/
YYYY
Please list any food allergies or medical conditions where immediate medical attention may be needed.
For example, Peanut allergy, type-1 diabetes, allergic to grass, etc.
Please list any non-emergency food sensitivities or dietary preferences  (i.e., Red dye 40, gluten or dairy allergy, etc.)
Third Child's Information
Child's First Name
Child's Last Name
Child's Date of Birth
MM
/
DD
/
YYYY
Please list any food allergies or medical conditions where immediate medical attention may be needed.
For example, Peanut allergy, type-1 diabetes, allergic to grass, etc.
Please list any non-emergency food sensitivities or dietary preferences  (i.e., Red dye 40, gluten or dairy allergy, etc.)
Fourth Child's Information
Child's First Name
Child's Last Name
Child's Date of Birth
MM
/
DD
/
YYYY
Please list any food allergies or medical conditions where immediate medical attention may be needed.
For example, Peanut allergy, type-1 diabetes, allergic to grass, etc.
Please list any non-emergency food sensitivities or dietary preferences  (i.e., Red dye 40, gluten or dairy allergy, etc.)
Additional Information
Please list any additional information that you would like us to be aware of.
A snack list with full ingredients will be emailed to you the week before VBS. If my child is unable to participate in snack due to dietary restrictions or allergies, I understand it is my responsibility to provide an alternative snack in a disposable, labeled container.
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