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Participant Registration

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Bethany Church

Location

1208 Brookside Road

Allentown, PA 18106

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Contact Brittney Lutseo:

610-395-3613

Blutseo@bethanychurchpa.com

First, Tell Us About Yourself:

Parent Information

Welcome! We're glad your here!

This is the registration for Bethany Church VBS in Allentown, Pa on June 22-26, 2026.

Bethany VBS:

Who: Children 4 yrs old to 6th grade

Time: 9:15am-12:00pm

Days: Monday through Friday

Location: 1208 Brookside Road, Allentown, Pa

Cost: Free

Fill out the form below to register!

AND - Returning for its second Year!:

VBS Plus- Powered by Push the Rock is an extended VBS program that will continue the fun until 3pm! Spots are limited, so don't wait to register!

Who: Children 4 yrs old to 6th grade

Time: 12:00pm-3:00pm (regular VBS ends at 12:00pm, extended VBS starts immediately after)

Days: Monday through Friday

Location: 1208 Brookside Rd, Allentown Pa

Details: Children must have a packed, NUT FREE, lunch labeled with their full name

Kids MUST be registered for our regular VBS program in order to register for VBS Plus. Any child who is not registered for our regular VBS program will not be able to attend or participate in VBS Plus. If you would like to register your child for VBS Plus, you need to complete the registration for both VBS AND VBS Plus. We cannot use your regular VBS registration as your registration for VBS Plus.

To Register for VBS Plus, complete VBS registration and then return to the VBS main page.

Thank you! Looking forward to an amazing week!

*Children must be at least 4 years of age by June 15, 2026 to participate in VBS. Have a little one under 4 years old? Find out more about our volunteer only, under age program.

Please enter PARENT / GUARDIAN information

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Phone

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Emergency Contact Relationship

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List all persons permitted to pick up child. Please include your name if you will be picking up. Please include first and last name, and list family members together - i.e. John & Jane Doe. Only people listed will be permitted to pick up child.

Persons permitted to pick up

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Photograph and Video Release: I grant Bethany Church, its representatives and employees the right to take photographs of my child and their property in connection with church promotions.

Photo/ Video Release

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Medical Release: I understand that in the event medical intervention is needed, every attempt will be made to contact the persons listed on this registration form. In the event I cannot be reached in an emergency, I hereby give permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or to order an injection, anesthesia, or surgery for my child as deemed necessary.

Accept Medical Release

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Liability Release: I understand all reasonable safety precautions will be taken at all times by Bethany Church and its agents. I understand the possibility of unforeseen hazards and know the inherent possibly of risk. I agree not to hold Bethany Church, its leaders, employees and volunteer staff liable for damages, losses, diseases or injuries incurred by the subject of this form.

Accept Liability Release

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Church Affiliation

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

Pease enter PARTICIPANT information

First Name

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Last Name

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Gender

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*Children must be at least 4 years of age by June 15, 2026 to participate in VBS. Have a little one under 4 years old? Find out more about our volunteer only, under age program.

My child meets the 4 years of age minimum by June 15, 2026

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Date Of Birth

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Grade Leaving

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Parent / guardian is a VBS volunteer

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Please review the following list of snacks that will be served the week of VBS. If your child cannot have a snack served at VBS, please provide an alternate snack for that day in a bag labeled with your child's name and give it to his or her crew leader.

VBS day	Snack
Monday	Millville Rice Crispies-gluten free, no allergens listed) Bakers Corner Marshmallows (gluten free, no allergens listed)
Tuesday	Millville Fruit Rounds-Contains wheat
Wednesday	Lunch Buddies Vanilla Pudding Cups-Allergens: milk
Thursday	Clancy's Pretzel Rods-Allergens: wheat, soy Bakers Corner Chocolate Frosting-Allergens: soy Southern Grove Raisins-no allergens listed
Friday	Ice Pops - no allergens listed

I have reviewed the list of snacks being served during the week of VBS and it is ok for my child to have them.

All snacks are ok

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Please provide information about your child's allergies. If your child requires an EPI pen, please indicate that below. During the week of VBS please provide one in a bag labeled with the child's name and give it to his or her crew leader. If your child doesn't have allergies, please enter 'N/A'.

Allergies

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Please provide information about your child's medical or special needs. If none, please enter 'N/A'.

Medical/Special Needs

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Comments

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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*Note: If your child would like to be with a friend or sibling who is in a younger age group, both children will be placed in the younger group if the older child and younger child are a maximum of one grade difference, e.g. a 3rd grade child can be placed in a 2nd grade crew, but not a 1st grade crew. This helps with staffing our crews appropriately.

Our policy doesn't allow younger children to be placed in an older group.

Thank you for your understanding!

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