VBS 2025

Parent/Guardian

First Name

Last Name

Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Number of Kids you are signing up

Childs Name

First Name

Last Name

Grade

Allergies

Childs Name

First Name

Last Name

Grade

Allergies

Childs Name

First Name

Last Name

Grade

Allergies

Childs Name

First Name

Last Name

Grade

Allergies

Childs Name

First Name

Last Name

Grade

Allergies

Childs Name

First Name

Last Name

Grade

Allergies

Permission to use Photos and Video

I hereby grant permission for Captivate Community Church to use sound, images or video of my child while attending this VBS program for print, website, and social media platform purposes.

Yes

No

Signature