vbs - Child registration Form

*Please complete this form thoroughly.  Missing information will slow down the drop off process on the first day.  Thank you!

*VBS is a free ministry offered to everyone from our community and the surrounding areas.  We are thrilled to be able to keep this ministry free and would like to thank all of our generous donors from VBS 2022 who made this possible!

Child's First Name

Child's Last Name


Date of Birth

mm/dd/yyyy *Must be 4 yrs old by 12/01/2023

Grade Entering In September 2023

Home Address




Phone Number


Allergies and other concerns

Please let us know of any allergies or other medical concerns

Is your child's tetanus vaccine up to date?

Benadryl Permission

If your child is having an allergic reaction, can our adult staff give your child an age appropriate dose of Benadryl?

Medical Release

I give permission for my child to receive medical treatment while he/she is under the supervision of the VBS staff of Faith Lutheran Brethren Church.

Mother's First and Last Name

Mother's Cell Phone


Mother's Email Address

Father's First and Last Name

Father's Cell Phone


Father's Email Address

Alternate Contact First and Last Name

In the event of an emergency, we will contact parents first. In the event that we cannot reach either parent, please provide an additional contact

Alternate Contact Phone


Alternate Contact Relation to Child

Closing Program

Do you plan to attend our closing program Friday, August 9th at 7pm?

Photo Permission

I give permission for Faith Lutheran Brethren Church to use photographs containing my child for our closing program slideshow and for my child's picture frame craft.

More Information

Would you like more information about other ministries we offer at our church?


Does your child have their own Bible?


If you have any questions or comments, please let us know!