Illumination Station VBS 2026
    Choose one:
     
     
     
    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
    *Participant's First Name:
    *Participant's Last Name:
    *Birthday:
    (MM/DD/YYYY)
    Gender:
    *Parent/Guardian Name:
    *Address:
    *City:
    *State:
    *Zip:
    *Cell Phone:
    (555-555-5555)
    Work Phone:
    (555-555-5555)
    *Email:
    *Last Grade Completed:
    Teammate Request:
    (Is there anyone your child would like to be on a team with?)
    Team Leader Request:
    (Is there a team lead your child wants to be with?)
    Allergies, Medical, & Special Needs:
    (Leave Blank if None)
    *Emergency Contact Name (1):
    *Emergency Contact Phone (1):
    (555-555-5555)
    Authorized Pickup #1:
    If so, where?
    May we have permission to photograph your child?
    May we have permission to use your child's photograph in church publications?
    *Waiver:
    (By entering my name or initials, I give permission for my child to participate in VBS, understand that participation involves inherent risks, and assume those risks on my child’s behalf. I waive any c)
    2001-2026 Lifeway Christian Resources3.20.03
    Privacy
    Contact
    Support