Illumination Station
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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
    We are excited about your child coming to VBS at Swartz First Baptist, June 1-5, 2026. Please complete the information below to register your child.
    *Participant's First Name:
    *Participant's Last Name:
    *Parent/Guardian Name:
    *Address:
    *City:
    *State:
    *Zip:
    *Primary Phone:
    (555-555-5555)
    Cell Phone:
    (555-555-5555)
    *Email:
    *Birthday:
    (MM/DD/YYYY)
    *Gender:
    *Last Grade Completed:
    Allergies, Medical, & Special Needs:
    (Leave Blank if None)
    Support:
    (Is there anything important we should know to best support your child this week?)
    Benefit your Child:
    (Would your child benefit from a one-on-one buddy during VBS?)
    Diagnosis or Need:
    (Would you like to share a diagnosis or specific need that helps us understand your child better?)
    *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:
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