VBS 2022 @ VBC Sugar Grove Campus

Participant Registration

If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)

Personal Information

Note: ONLINE REGISTRATION OFFICIALLY CLOSED ON 6/12/2022. Walk-in registrations will be allowed on Monday, June 20 when doors open at 8:45 a.m. if space allows. As of 6/3/2022, our PK/K has reached capacity and is closed for registration.
*Participant's First Name:
*Participant's Last Name:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
*Cell Phone: (555-555-5555)
*Email:
*Birthday: (MM/DD/YYYY)
*Grade in fall of 2022:
*T-Shirt Size:
*Gender:
*Church attendance: (Do you regularly attend Village Bible Church in Sugar Grove?)	Yes No
Church Name: (If you attend a different church, please list the name of your home church.)
Allergies, Medical & Special Needs: (Leave blank if not applicable)
*Health Insurance Company:
*Insurance Policy Number:
*Physician's Name:
*Physician's Phone Number:
*Medical authorization in case of an emergency: (I authorize any VBC VBS adult leader to make emergency medical decisions for my child in the event that our listed emergency contact and I cannot be reached. Checking YES suffices as my signature.)	Yes No
*Emergency Contact Name (1):
*Emergency Contact Phone (1): (555-555-5555)
*Authorized Pickup #1:
Authorized Pickup #2:
Comments: