VBS Elementary Student Registration

PARENT INFORMATION

Parent Name

This address will receive a confirmation email

Best Phone

Address

CHILD 1

Note: Cornerstone Kids' Vacation Bible School is for children FINISHING Kindergarten through FINISHING 5th Grade. If your child is younger than this cut-off, we offer PreK VBS for children of leaders who are serving (sign up here!). If your child is older and wants to help at VBS, they can register as a Youth Helper through the Leader Registration Form

Child 1 Name (first & last)

Birthdate

Grade FINISHING in Spring 2026

T-Shirt Size

Does your child have any medical or allergy concerns we need to know about?

Yes No

If so, please list any here:

CHILD 2

If you are only registering one child, please skip to "Additional Information" section.

Child 2 Name (first & last)

Birthdate

Grade FINISHING in Spring 2026

T-Shirt Size

Does your child have any medical or allergy concerns we need to know about? Yes No

If so, please list any here:

CHILD 3

If you are only registering one child, please skip to "Additional Information" section.

Child 3 Name (first & last)

Birthdate

Grade FINISHING in Spring 2026

T-Shirt Size

Does your child have any medical or allergy concerns we need to know about? Yes No

If so, please list any here:

CHILD 4

If you are only registering one child, please skip to "Additional Information" section.

Child 4 Name (first & last)

Birthdate

Grade FINISHING in Spring 2026

T-Shirt Size

Does your child have any medical or allergy concerns we need to know about? Yes No

If so, please list any here:

ADDITIONAL INFORMATION

Emergency Contacts Names and Phone numbers (other than listed above)

Who may pick up your child at the end of each VBS day?

Does your child attend church regularly? If so, where?

If your child is visiting our church, who are they a guest of?

Media Release: By attending VBS at Cornerstone Church, I am releasing permission of my child(s) photo or video to be used for promotional purposes. Please check the box if you agree.

Yes

FAMILY MEDICAL RELEASE

The information provided below can help emergency medical personnel provide time sensitive care for your child. Cornerstone Church will keep a digital copy on hand for each child to accompany them in the event of a medical emergency. All information will be securely disposed of after the completion of Vacation Bible School.

Medical Insurance Company (if left blank this could interrupt medical treatment in case of emergency)

Insurance Policy Number

Physician name and phone number if important for emergency medical treatment

Medical Release: This consent form gives permission to seek medical attention as deemed necessary and releases the Church and its staff of any liability against personal losses of named child. In the event that he/she is injured and requires the attention of a medical provider, I consent to any reasonable medical treatment as deemed necessary by a licensed provider. In such an event where treatment is required, from a provider and/or hospital personnel designated by the Church, I agree to hold such person(s) free and harmless of any claims, demands, or suits for damages arising from the giving of such consent.

Agree

PAYMENT SUBMISSION

Choose how many children:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

VBS Elementary Student Registration

Description

Please Fix the Following