EmailMeForm
VBS Form | 19 and Older Classes
Your Name
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Parent / Guardian's Name (if needed)
Gender
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Male
Female
Your Age
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Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Your Phone Number
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Email
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Add any additional students below. Include there name and gender. Thank you!
For example: John Doe, male
Jane Doe, female
Would you like to receive text messages regarding VBS and any future VBS information/communication? By selecting "Yes" you give New Jerusalem M.B. Church permission to send you text messages regarding VBS and future VBS communication.
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Yes
No
New Jerusalem Church Member
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Yes
No
If no, where is your church home, if you have one?
Permission to use your photograph in church publications (printed pieces and church website)?
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Yes
No
Emergency Information
Emergency Contact Name
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Emergency Number
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Medical
Food Allergies / Medical Issues
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Yes
No
If yes, please list them all here:
Release Disclaimer and Electronic Signature: I certify that all the information in my registration submission is accurate and true. I release New Jerusalem M. B. Church and Unity M.B. Church of all liability of above named person while participating in Vacation Bible School in said time June 23-27, 2025.
I verify that I am 19 years of age or older. Please leave your electronic signature below.
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Clear
Please retype your name below. Thank you!
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VBS Disclaimer
We don't New Jerusalem M. B. Church / Unity M. B. Church disclose information (personal or general) collected by our site, via our online forms. Although, we won't ever ask for your personal information like Social Security Numbers, Account Numbers, etc.
We only use information collected from our online forms to tally a count of participants for events and to contact them in case of event updates and changes, to respond to members (if the online form is specifically for members of New Jerusalem), or to share any other pertinent communication that's needed, after online form information is submitted.
