EmailMe Form - VBS Form | Pre-K thru 12th Grade

*NOTE: We are asking that 3 year olds are potty trained should they attend VBS. If not, we are requiring parents to remain with them.

Child's Name *

Age *

What grade are they (2026-2027) school year? *

Gender *

Male

Female

Allergies? If yes, please include them below. *

No

Yes

List allergies below.

Additional Child? *

Yes

No

Additional Child's Name *

Additional Child's Age *

What grade are they (2026-2027) school year? *

Additional Child's Gender *

Male

Female

Allergies? If yes, please include them below. *

No

Yes

List allergies below. *

Additional Child 2? *

Yes

No

2nd Additional Child's Name *

2nd Additional Child's Age *

What grade are they (2026-2027) school year? *

2nd Additional Child's Gender *

Male

Female

Allergies? If yes, please include them below. *

No

Yes

List allergies below. *

Additional Child 3? *

Yes

No

3rd Additional Child's Name *

3rd Additional Child's Age *

What grade are they (2026-2027) school year? *

3rd Additional Child's Gender *

Male

Female

Allergies? If yes, please include them below. *

No

Yes

List allergies below. *

Additional Child 4? *

Yes

No

4th Additional Child's Name *

4th Additional Child's Age *

What grade are they (2026-2027) school year? *

4th Additional Child's Gender *

Male

Female

Allergies? If yes, please include them below. *

No

Yes

List allergies below. *

Additional Child 5? *

Yes

No

5th Additional Child's Name *

5th Additional Child's Age *

What grade are they (2026-2027) school year? *

5th Additional Child's Gender *

Male

Female

Allergies? If yes, please include them below. *

No

Yes

List allergies below. *

Parent / Guardian's Name *

Parent / Guardian's Email *

Address *

City / State / Zip Code *

Home Phone *

Cell Phone *

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. *

Yes

No

Emergency Information

Emergency Contact Name *

Emergency Number *

Dismissal / Pickup

How will your child be picked up each night? *

Personal Vehicle - Decals will be given to display on dashboard

New Jerusalem Van

Unity Van

Permission to use your child's / children photograph in church publications (printed pieces and church website)? *

Yes

No

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 22-26, 2026.

Special Note:

We encourage ages 3 years to 18 years to wear tennis shoes for recreation activities.

VBS Disclaimer

We don't New Jerusalem M. B. Church / Unity 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.

Parent and/or Guardian, leave your electronic signature. Thank you! *

Clear

Please retype your name below. Thank you! *