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Towamencin Mennonite Church
VBS Registration
June 16-20, 2025
5:45 pm - 8:30 pm
Please fill out the form below to register for VBS
Parent/Guardian First Name*
(Please only one name, add additional persons under authorized pickup)
Last Name*
Email Address*
Primary Phone*
Secondary Phone
Street Address*
City*
Parent/Guardian Info
Parent/Guardian First Name*
(Please only one name, add additional persons under authorized pickup)
Last Name*
Email Address*
Primary Phone*
Secondary Phone
Street Address*
City*
State*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip*
Emergency Contact Name*
Emergency Contact Phone(s)*
Relation to Emergency Contact*
How did you hear about our VBS?*
Choose Option
Received mailed invitation
Personal/Friend invitation
Web Site
Road Sign
Other
Enter Student Info
Student First Name*
Student Last Name*
Student Gender*
--Gender--
Female
Male
Shirt Size*
--Shirt--
Child - XS
Child - SM
Child - MED
Child - LG
Adult - SM
Adult - MED
Adult - LG
Adult - XL
Grade Completed as of 6/16/2025 ** (Children must be 4 years old and must be potty trained.)
Preschool 4-5
Kindergarten
1
2
3
4
5
6
7 and 8
Birthdate * Must Be 4 Years Old by 6/16/2025
Concerns
To Add Additional Students Click
1 Student Registered
To Delete or Remove Last Student Click
Please list people who are authorized to pickup these students
Other than parent listed above
First Name
Last Name
Phone
To Add additional Authorized Pickups,
other than parent listed above Click
To Delete or Remove Authorized Pickup
By registering, I understand that my child may appear in the VBS Video and/or in photographs (taken throughout the week).
I Agree to the above video/photo waiver
Please type the letters and numbers you see below
[ Different Image ]