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Participant Registration

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Palmerston Evangelical Missionary Church

Location

550 Prospect St.

Palmerston, ON N0G 2P0

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Contact VBS Committee :

519-343-3740

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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City

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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 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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Alternate Pickup 2 Name

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Alternate Pickup 2 Phone

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Permission to Attend. I give permission for my child, named below, to attend the Vacation Bible School program at Palmerston Evangelical Missionary Church (PEMC) on July 6 to 10, 2026. I acknowledge that typing my name below will serve as an electronic signature, and I certify that I am the parent or guardian of the aforementioned child.

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Photo Release (Optional). I grant PEMC permission to use photographs of my child, taken during VBS onscreen during the VBS program and/or other in-church presentations

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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

Which session will they be attending?

Please note:

If your child is going into JK, they need to be potty trained to attend VBS.
We at PEMC will do our best to accommodate all dietary needs but cannot guarantee that all requests will be met. Feel free to bring a snack for your child (clearly marked as to who it is for).

First Name

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Last Name

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Grade Entering

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Gender

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Date Of Birth

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Allergies

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Medical Concerns

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Any other items you feel we should be aware of (e.g., special needs etc.):

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Preferred Name (e.g., nickname)

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