Registrations Registrations Please enable JavaScript in your browser to complete this form.Name (of Participant) *FirstLastName (of Participant) (Only fill out if registering more than one child)FirstLastName (of Participant) (Only fill out if registering more than one child)FirstLastGrade of Participant? (This event is open for students entering Pre-K to finishing 5th grade for the 2025-2026 school year.) *Pre-KKindergarten1st grade2nd grade3rd grade4th grade5th gradeGrade of Participant #2?N/APre-KKindergarten1st grade2nd grade3rd grade4th grade5th gradeGrade of Participant #3?N/APre-KKindergarten1st grade2nd grade3rd grade4th grade5th gradeGender (of Participant): *MaleFemaleGender (of Participant #2):N/AMaleFemaleGender (of Participant #3):N/AMaleFemaleParent/Guardian Name: *Parent/Guardian Phone Number: *i.e. 260-622-7449Email * event have At Mailing Address: *Emergency Contact (Different than Parent/Guardian): *Emergency Contact Phone Number: *i.e. 260-622-7449Relationship to Student: *Allergies? Medical Concerns? Physical Concerns/Limitations? *At the end of VBS each day, my student will be: *Walking home and may leave when readyPicked upIf the student is being picked up, they will be required to wait until the parent/guardian shows up. If someone else will be picking them up, a note must be sent with the student.Parent/Guardian Signature: *By typing your name in this box, you give permission for your child to participate in our Make a Splash VBS Event.Are there any custody concerns or anyone who cannot pick-up your child? *NoYesIf yes, please explain:Do we have permission to post pictures of your child on Facebook? *YesNoThird ChoiceQuestions/Comments?Submit
