VBS 2025 REGISTRATION FORM

JOSEPH’S JOURNEY FROM PRISON TO PALACE

Dates: August 2nd-5th 6:00-8:30 (light dinner served at 5:30)
Ages: 2 years old through rising 6th graders

SOUTH FORK CHURCH OF CHRIST
205 Keating Drive, Winston Salem, NC
336-768-0249
www.SouthFork.cc

to Special Photo

Child's Name *

First

Last

Child's Age *Child's Age as of August 2, 20252 years old3 years old4 years old5 years old6 years old7 years old8 years old9 years old10 years old11 years old12 years old13 years old

What age will your child be at the VBS start (Aug. 2, 2025)?

Child's Gender

• Male
• Female

What grade will you child enter into this fall? *What grade will you child ENTER into this fall?Entering Pre-KEntering KindergartenEntering 1st GradeEntering 2nd GradeEntering 3rd GradeEntering 4th GradeEntering 5th GradeEntering 6th Grade

What grade will your child be entering this fall (25-26 school year)?

Allergies *

-If none, please write “NONE”

Medical or Special Needs *

-If none, please write “NONE”

Parent/Guardian Name *

First

Last

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Parent/Guardian Phone *

Parent/Guardian Email *

Email

Confirm Email

What is your home church? (if applicable)

Emergency Contact (First and Last Name) *

If the same as the Parent/Guardian listed above, please write “SAME".

Emergency Contact Phone *

Provide the phone number of your emergency contact.

Alternate Pick-Up Person? *

• ONLY I will pick up my child
• I authorize another to pick up my child

Additional authorized pick-up person?

Provide First and Last Name.

Alternate Pick-Up Person's Phone

Provide the phone number of your emergency contact.

Medical Release *

• MEDICAL RELEASE: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand the VBS staff will contact emergency services in the event of a significant injury, and all expenses for such emergency services will be paid by me.

Photo Release *

• PHOTO RELEASE: I hereby grant the above-named church permission to use photographs/videos taken at VBS of the minor designated above, in any lawful manner. I waive any right to inspect or approve the finished product or written copy that may be used in conjunction therewith, or the use to which it may be applied.

Permission to Attend *

• PERMISSION TO ATTEND: I give my permission for my child (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church (South Fork Church of Christ).

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