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First Evangelical Presbyterian Church

Location

2000 West Jefferson Street

Kokomo, IN 46901

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Contact Ellen Engelhardt:

765-457-8201

first.epc.nursery@gmail.com

First, Tell Us About Yourself:

Parent 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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Text Message Phone

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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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Home Church Affiliation

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Where Did You Hear About Our Vacation Bible School?

Multiple selections are allowed.

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(Other - Please Specify)

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Comments

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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

Open to children age 4 Through Completed Grade 5

First Name

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Last Name

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Gender

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Age

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Child must be at least age 4 as of June 22, 2026.

Date Of Birth

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For children age 4 and up who have not yet attended kindergarten, please select Pre-K below. Kindergarten and Pre-K children will be placed in preschool crews. Children who have just completed grade 1, 2, 3, 4, or 5 will be placed in elementary crews.

Grade Leaving

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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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Allergies

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Medical Concerns

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Family Physician Name and Phone Number

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MEDICAL CONSENT

I hereby state that I am the parent or legal guardian of the above-named minor child. I authorize Ellen Engelhardt, Team Leader of Children and Family Ministries at First Evangelical Presbyterian Church, 2000 W. Jefferson, Kokomo, Indiana, to consent to any necessary examination, anesthetic, medical diagnosis, surgery or treatment, and/or hospital care to be rendered to the above-named minor under general supervision and on the advice of any physician or surgeon licensed to practice in the state of Indiana. Please enter your name as a legal electronic signature.

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Date Signed

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PHOTO/VIDEO RELEASE

I consent to First Evangelical Presbyterian Church to use photos or videos of my child in publications which may include, but are not limited to, the church newsletter, church bulletin, church website, and printed media. Please enter your name as a legal electronic signature.

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Date Signed

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Comments

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