Vacation Bible School

Invite your kids to Illumination Station VBS for the brightest week of the year! While many people claim to know about Jesus, many are in the dark about who He really is. During VBS kids will explore all the ways light brightens, illuminates, reflects, and reveals.

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Parent/Guardian Name *

Email *

Cell Phone Number *

Address *

Address Line 1

Address Line 2

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Zip Code

How many children would you like to register? *--- Select Choice ---12345

Child Name #1 *

Birthday (Child #1) *

Last Grade Completed in School? (Child #1) *--- Select Choice ---SELECT ONEKindergarten1st2nd3rd4th5th6th

Child Name #2 *

Birthday (Child #2) *

Last Grade Completed in School? (Child #2) *--- Select Choice ---SELECT ONEKindergarten1st2nd3rd4th5th6th

Child Name #3 *

Birthday (Child #3) *

Last Grade Completed in School? (Child #3) *--- Select Choice ---SELECT ONEKindergarten1st2nd3rd4th5th6th

Child Name #4 *

Birthday (Child #4) *

Last Grade Completed in School? (Child #4) *--- Select Choice ---SELECT ONEKindergarten1st2nd3rd4th5th6th

Child Name #5 *

Birthday (Child #5) *

Last Grade Completed in School? (Child #5) *--- Select Choice ---SELECT ONEKindergarten1st2nd3rd4th5th6th

you (Child list

Do any of the children you registered have allergies? *

• Yes
• No

Please list allergies below *

Do any of the children you registered have any special medical needs we need to know about? *

• Yes
• No

Please list medical needs below *

Emergency Contacts (Names and Phone Numbers)

We will first reach out to the parent/guardian who registered the student. If we are unable to reach them, please list additional people we should reach out to.

Dismissal – Who may pick your child up at the end of the day?

List any approved people to pick up. If they are not on this list, they will not be allowed to pick up your student.

Are you a member of Ridgeway Baptist Church? *

• Yes
• No

Do you currently attend another church?

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