VBS Children's Registration 2025 | Valparaiso Baptist Church

Name (Required)

Email Address (Required)

Student Full Name: (each student/sibling must complete a separate application) (Required)

Last grade completed: (Required)

Does your child need assistance using the restroom or have any special needs we should be aware of to best support them during VBS? (Required)

Fully potty trained and independent

Needs some assistance (e.g., reminders, help with buttons/snaps)

Not potty trained/requires full assistance

Birthday: (Required)

Parent or legal guardian(s) full names: (Required)

Parent or legal guardian(s) phone numbers: (Required)

Full legal name of the person authorized for pickup (if not a parent or legal guardian):

Does your child have any food allergies or dietary restrictions we should be aware of? (Required)

Does your child have any special needs, medical conditions, sensory sensitivities, or behavioral considerations we should be aware of? How can we best support them? (Required)

We want to provide the best possible experience at VBS. If your child has any disabilities or special needs, please share any relevant information that will help us care for them well. The more details you provide, the better we can prepare. If we require additional information, we will contact a legal parent or guardian. If you prefer to be reached at a different phone number, please include it in the space below.

Does your child need to remain with a parent or guardian during VBS for any reason (e.g., medical, emotional, or behavioral support)? If yes, please provide the name of the parent or guardian.

Please note: any parent or chaperone attending with a child must be registered to volunteer separately.

Can your child’s photo be used in promotional material? (Required)

Permission Slip & Emergency Medical Waiver (Required)

I understand that this waiver pertains to any child participating in Vacation Bible School from July 23-26, 2025, and that the activities will take place at Valparaiso Baptist Church (612 Emmettsburg St, Valparaiso, IN 46385). EMERGENCY: In the event of any illness or injury, I hereby consent to whatever x-ray, examination, anesthetic, medical, dental, allergic, or surgical diagnosis or treatment and hospital care from a licensed physician and/or surgeon as deemed necessary for the safety and welfare of my child when I am not immediately available for consultation. I understand that every effort will be made to contact me as the guardian of my child in case of emergency. By answering "yes" below, I understand and agree with the statements above.

Child Conduct Acknowledgement (Required)

CHILD CONDUCT: I fully understand that for the safety of the children and the counselors, certain rules and regulations will be upheld. By signing this document, I agree that my child must accept and obey all rules and requirements governing conduct during VBS activities. It is understood that VBS may disallow my child further participation in VBS and VBS related activities if it is determined that they are in violation of these standards. By answering "yes" below, I understand and agree with the statements above.

Liability Waiver (please sign parent/guardian full name below) (Required)

I understand that this waiver pertains to any child participating in Vacation Bible School from July 23-26, 2025, and that the activities will take place at Valparaiso Baptist Church (612 Emmettsburg St, Valparaiso, IN 46385). EMERGENCY: In the event of any illness or injury, I hereby consent to whatever x-ray, examination, anesthetic, medical, dental, allergic, or surgical diagnosis or treatment and hospital care from a licensed physician and/or surgeon as deemed necessary for the safety and welfare of my child when I am not immediately available for consultation. I understand that every effort will be made to contact me as the guardian of my child in case of emergency. By signing my name below, I understand and agree with the statements above.