VBS 2026 Registration - Heritage Baptist Church | 6:30-8:30 PM
June, 8-11. 2026 6:30-8:30 PM | Please fill out this form and click submit.
Parent / Guardian Info
Full name
*
Email
*
This address will receive a confirmation email
Home phone
Cell phone
*
Home address
*
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BC
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IL
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KY
LA
MA
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MD
ME
MH
MI
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MO
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MT
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NS
NT
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OK
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PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
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VA
VI
VT
WA
WI
WV
WY
YT
Do you attend our church?
Please select one option.
Member
Regular attender
First time guest
Visiting
Select Option
Member
Regular attender
First time guest
Visiting
Child Information
Fill out only the number of children you are registering
Child 1 full name
*
Child 1 date of birth
*
Child 1 current grade
*
Please select one option.
K
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
K
1
2
3
4
5
6
7
8
9
10
11
12
Child 1 gender
*
Please select one option.
Male
Female
Select Option
Male
Female
Child 1 allergies
*
Child 1 medical conditions / special needs
Child 2
Child 2 full name
Child 2 date of birth
Child 2 current grade
Please select one option.
k
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
k
1
2
3
4
5
6
7
8
9
10
11
12
Child 2 Gender
Please select one option.
male
female
Select Option
male
female
Child 2 allergies
Child 2 medical condition / special needs
Child 3
Child 3 full name
Child 3 date of birth
Child 3 current grade
Please select one option.
k
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
k
1
2
3
4
5
6
7
8
9
10
11
12
Child 3 gender
Please select one option.
male
female
Select Option
male
female
Child 3 allergies
Child 3 medical condition/ special needs
Child 4
Child 4 full name
Child 4 date of birth
Child 4 current grade
Please select one option.
k
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
k
1
2
3
4
5
6
7
8
9
10
11
12
Child 4 gender
Please select one option.
male
female
Select Option
male
female
Child 4 allergies
Child 4 medical condition/ spacial needs
Child 5
Child 5 full name
Child 5 date of birth
Child 5 current grade
Please select one option.
k
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
k
1
2
3
4
5
6
7
8
9
10
11
12
Child 5 gender
Please select one option.
male
female
Select Option
male
female
Child 5 allergies
Child 5 medical condition/ spacial needs
Safety & Pickup
Emergency Contact Name
*
Emergency Contact Phone
*
Authorized Pickup Persons
*
Permissions
I authorize emergency medical treatment if needed
*
Please select all that apply.
Yes
No
Logistics
How did you hear about VBS ?
Please select one option.
Church
Friend
Social Media
Flyer
Other
Select Option
Church
Friend
Social Media
Flyer
Other
Please note, our team will be taking pictures/videos for church's use.
Submit
Description
June, 8-11. 2026 6:30-8:30 PM
Please fill out this form and click submit.
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