Registration – Palisades Community Bible Church

VBS Registration

Save time by using this form to register your children for Vacation Bible School. Once we receive your form we will send you a confirmation.

You can also come a little early and register at the door.

Parent(s) / Guardian(s) *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Alt. Phone

Email *

Does you attend a church? If so, where?

You have my permission to take photos and videos of my child/children and use this material on the PCBC website (and/or YouTube.com) and also for the end-of-week video. **Note that if you answer 'no' we will not take any photos or videos of your children except for use in crafts. *

Yes, it's ok to take photos and videos
No, please don't take any photos of my children

Child 1 *

First

Last

Age *

Grade_Entering *

Does your child have any allergies or special needs requirements? Please be specific. *

Child 2

First

Last

Age

Grade

Does your child have any allergies or special needs requirements? Please be specific.

Comment or Message

Phone