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Participant Registration

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Jeffersonton Baptist Church

Location

18498 Springs Road

Jeffersonton, VA 22724

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Contact Dylan Teaford:

540-498-3333

dteaford@jbcva.org

First, Tell Us About Yourself:

Parent Information

Thank you for registering for Illumination Station VBS at Jeffersonton Baptist Church! We cannot wait for your child to join us for an exciting week of games, worship, Bible adventures, snacks, and unforgettable moments that point kids to Jesus. If you have questions or special requests, please contact Pastor Dylan or Brittany Morton anytime.

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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Country

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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 Relationship

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Emergency Contact Phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Home Church Affiliation

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I understand that Jeffersonton Baptist Church may take pictures videos for in house use and promotional content. I understand that if I wish to remove my permission I must contact Pastor Dylan. dteaford@jbcva.org

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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

First Name

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Last Name

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Grade Entering

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Nursery Information (Ages 4 & Under): Our nursery during VBS is primarily reserved for children of volunteers serving throughout the week. If your family is interested in utilizing nursery care for children ages 4 and under, please contact Pastor Dylan at dteaford@jbcva.org before registering so we can discuss availability.

Gender

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Date Of Birth

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Shirt Size

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Allergies

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Medical Concerns

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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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Friend 3 First Name

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Friend 3 Last Name

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Comments

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