Illumination Station VBS
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    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
    PreK group AND 1st and 2nd Grade group is full we cannot accept any more registrations for these groups, All other groups please register for the grade your child will complete in June 2026.
    *Participant's First Name:
    *Participant's Last Name:
    *Preferred Name for Name Tag:
    *Parent/Guardian Name:
    *Address:
    *City:
    *State:
    *Zip:
    Primary Phone:
    (555-555-5555)
    Work Phone:
    (555-555-5555)
    *Cell Phone:
    (555-555-5555)
    *Email:
    *Birthday:
    (MM/DD/YYYY)
    *Last Grade Completed:
    Allergies, Medical, & Special Needs:
    (Leave Blank if None)
    *Emergency Contact Name (1):
    *Emergency Contact Phone (1):
    (555-555-5555)
    Emergency Contact Name (2):
    Emergency Contact Phone (2):
    (555-555-5555)
    *Authorized Pickup #1:
    *Authorized Pickup #2:
    Authorized Pickup #3:
    Authorized Pickup #4:
    Are you a member of this church?
    Guest of:
    Do you attend Church?
    If so, where?
    May we have permission to photograph your child?
    May we have permission to use your child's photograph in church publications?
    Comments:
    Gender:
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