VBS 2025_KIDS REGISTRATION FORM

Child Info

Name

Child Photo

Upload (8MB)

Age

Grade (2024-2025 School Year)

Allergies / Medical Condition

Parents Info

Father's First & Last Name

Father's Phone Number

Mother's First & Last Name

Mother's Phone Number

This address will receive a confirmation email

Home Address

Authorized List for Pick Up

Due to safety and security concerns, your child will only be allowed to leave our property with either the primary parent/guardian, or an adult listed here.

Name

Relation to Child

Father/Mother Grandpa/Grandma Uncle/Aunt Brother/Sister Other

Name

Relation to Child

Father/Mother Grandpa/Grandma Uncle/Aunt Brother/Sister Other

Name

Relation to Child

Father/Mother Grandpa/Grandma Uncle/Aunt Brother/Sister Other

Name

Relation to Child

Father/Mother Grandpa/Grandma Uncle/Aunt Brother/Sister Other

Description

Welcome! We are excited to host another Week of VBS! To save you significant time and help us speed up the registration process, Complete a SEPARATE FORM for EACH child that you are registering.

*VBS is for students in grades K4 up to those that just completed 6th Grade.
*K4 must be 4 years of age, self-governed and potty-trained.

DATE & TIME
Monday - Wednesday, July 28th - 30th @ 6-8:30pm (Doors open at 5:45pm each night)

LOCATION
Pioneer Baptist Church
4252 Garfield Avenue
Carmichael, CA 95608
916-726-3100
info@pioneerca.org

VBS 2025_KIDS REGISTRATION FORM

Description

Please Fix the Following