VBS Registration Form

Child's First Name *

Child's Last Name *

Child's Nickname

Street Address *

City *

Province *

Postal Code *

Child's Gender

M

F

Child's Age (As of July 2026) *

Child's Upcoming Grade (Fall 2026) *

Date of Birth *

Snack Options:

Vegetarian

Plant-based

Food Allergies or Restrictions

Yes

No

If Yes, Please Specify

Environmental Allergies (Other):

Yes

No

If Yes, Please Specify

Medical Condition(s) or any special circumstances we should be aware of (special needs or disabilities, and/or specific considerations).

Yes

No

If Yes, Please Specify

Would you like VBS Nurse Volunteer to help your child for Medical Condition:

Yes

No

If Yes, Please Specify

First Name of Guardian/Parent *

Last Name of Guardian/Parent *

Relationship to Child

Email

Cell Phone *

Home Church

Custodial Arrangement (if applicable)

Photographs and video will be taken during VBS. Do you give permission for your child’s photo to be taken?

Yes

No

Date *

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