VBS Registration

Parent/Guardian

Parent/Guardian First Name Parent/Guardian Last Name Street Address City | State | Zip

Contact Phone Numbers

E-Mail Address Confirm E-Mail Address

Emergency Contact

Full Name Relationship Phone Number

Participant Information

Child's First Name

Please enter only the name you want your child to be called by others. What you enter here will be on your child's nametag.

Child's Last Name Gender Home Church

Optional

Child's Date of Birth

Must be 4 years old by June 1, 2026.

Grade Leaving This Spring

Please select the grade your child is leaving this spring.

Session Attending

Allergies and Medical

Allergies

Does your child have any allergies?

Yes No

Medical

Does your child have any medical conditions or special needs (physical, learning, or behavioral) we should be aware of?

Yes No

Shadow/Buddy

Based on your child's needs, would a shadow or buddy be beneficial?

Yes No

If your child's needs warrant special handling during VBS you will be contacted by a nurse prior to the first day.

Security

Security Word

Please enter a Security Word that can be used to pick up your child from VBS. We will not allow anyone to pick up your child without this word. Anyone with this word will be permitted to pick up your child.

Optional Friend Request

Friend Request
Optional - Limit 1

You may optionally enter the first and last name of ONE friend that you would like to be placed in the same crew as your child. Friends must request each other and also register for the same session and be in the same age group. Friend requests are not guaranteed but we will make every effort to place them in the same crew. If a friend request has more than one name listed, it cannot be honored.

I understand and would like to enter a friend request for my child.

Yes No

Consent

Medical Consent

By checking this box, you give permission for the VBS Staff at Mt. Horeb to provide and secure medical treatment for your child, including transportation and hospitalization, in the event of an emergency. Your consent is required in order to register your child for VBS.

I Consent

Photo Consent

By checking this box, you give permission for photos taken during VBS to be used for promotional purposes including printed, electronic, and church social media. Your consent is required in order to register your child for VBS.

I Consent

Welcome to Rainforest Falls at Mt. Horeb!

Parent/Guardian

Emergency Contact

Participant Information

Allergies and Medical

Security

Optional Friend Request