Vacation Bible School, 2025

Child's Name *

First Name

Last Name

Child's Birth Date

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian #2, if applicable

First Name

Last Name

Mobile Phone #1 *

(###)

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Mobile Phone #2

(###)

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Home Phone

(###)

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Work Phone

(###)

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Emergency Contact #1 *

First Name

Last Name

Phone for Emergency Contact #1 *

(###)

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Emergency Contact #2

First Name

Last Name

Phone for Emergency Contact #2

(###)

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Doctor *

First Name

Last Name

Doctor's Phone *

(###)

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May we use your child's anonymous image for communications and social media? *

Yes

No

A friend you'd like to have your child grouped with (the friend's registration should also indicate this preference.)

First Name

Last Name

Who is allowed to pick up your child at the end of their day with us? *

First Name

Last Name

Second person allowed to pick up your child.

First Name

Last Name

Vacation Bible School is $100 per child. Please indicate which payment method you’ll use: *

Online at HilltopChurch.org, select Donate then “Give to VBS” in the fund field.

By check sent to the church office

Other (please give details in the box below)