Camp Chaos VBS Registration Form 2025
Please fill out this form and click submit.
Child's Name
*
Child's Birthdate
*
Grade Last Completed
*
Please select one option.
PK-4
K
1st
2nd
3rd
4th
5th
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Parent/Guardian Name
*
Parent/Guardian Phone #
*
Emergency Contact Name
*
Emergency Contact Phone #
*
Who can pick up your child? (Will be asked to show ID)
*
Does your child have any food allergies?
*
Does your child have any medical concerns we might benefit from knowing during VBS? Please explain.
*
Permission to use Images and Video: I hereby grant permission for Meldrim Baptist Church to record sounds, images, or video of my child, whose name is listed on this registration form. While attending this VBS program, I also give permission for Meldrim Baptist Church at its sole discretion, to use the sounds, images, or videos in publications (including print, websites and social media platforms) owned by Meldrim Baptist Church in relation to this VBS program. (Please sign by typing your name and date.)
*
Submit
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