Rice Community VBS - Child Registration 2026

Parent's Information

Name

This address will receive a confirmation email

Phone

Address

Additional Phone Number for Emergency Contact

Do you have a home church?

Yes No

Home Church Name

How many children will be attending

Child #1

First Name

Last Name

Sex

Age

Bithdate

Grade Level Just Completed

Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th/5th Grade

Does your child have allergies?

Does your child have any special needs?

Child #2

First Name

Last Name

Sex

Age

Birthdate

Grade Level just completed preschool Kindergarten 1st grade 2nd grade 3rd grade 4th/5th grade

Does your child have any allergies?

Does your child have any special needs?

Child #3

First Name

Last Name

Sex

Age

Birthdate

Grade Level Just Completed Preschool Kindergarten 1st grade 2nd grade 3rd grade 4th/5th grade

Does your child have any allergies?

Does your child have any special needs?

Child #4

First Name

Last Name

Sex

Age

Birthdate

Grade Level Just Completed Preschool Kindergarten 1st grade 2nd grade 3rd grade 4th/5th grade

Does your child have any allergies?

Does your child have any special needs?

Child #5

First Name

Last Name

Sex

Age

Birthdate

Grade Leve Just Completed Preschool Kindergarten 1st grade 2nd grade 3rd grade 4th/5th grade

Does your child have any allergies?

Does your child have any special needs?

Medical Release

By checking this box, I give my permission for the VBS staff to administer basic first aid to my child if injured. I understand the VBS staff will contact emergency services in the event of a significant injury and all expenses will be paid by me

Medical and Media Release

Media Release By checking this box, I give Shepherd of the Pines permission to use photographs/videos taken at VBS of my child.

Permission

By checking this box, I give permission for my child (named above) to attend the Vacation Bible School listed above. I understand that the information I give for this registration will only be used by the VBS hosting church.

Electronic Signature*

*By entering my name in the box above, I am providing my electronic signature on this form.

Description

May 31st to June 4th 6:30-8:30pm

This Year we will only be taking 20 kids per grade NOTE 4th/5th WILL BE ONE CLASS

This is a FREE VBS! It's Sunday, May 31st to June 4th from 6:30pm - 8:30pm. Max will be 120 kids and will be first come first serve basis we will only be taking 20 kids per grade.

Rice Community VBS - Child Registration 2026

Description

Please Fix the Following