Parent/Guardian's Name * First Name Last Name Parent/Guardian's Email * Parent/Guardian's Phone Number * (###) ### #### Emergency Contact Information Emergency Contact's Name * First Name Last Name Relationship to Child * Emergency Contact's Phone Number * (###) ### #### Child # 1 Child's Name * First Name Last Name Gender * Male Female Child's Date of Birth * Month/Day/Year MM DD YYYY Grade for the 2025/2026 School Year * Knd. 1st 2nd 3rd 4th 5th 6th List any allergies, dietary restrictions, or anything else we should know about your child. If you are finished registering, please scroll to the bottom of this page and click the SUBMIT button. Child # 2 Child's Name First Name Last Name Gender Male Female Date of Birth Month/Day/Year MM DD YYYY Grade for the 2025/2026 School Year Knd. 1st 2nd 3rd 4th 5th 6th List any allergies, dietary restrictions, or anything else that we should know about your child If you are finished registering, please scroll to the bottom of this page and click the SUBMIT button. Child #3 Child's Name First Name Last Name Gender Male Female Date of Birth Month/Day/Year MM DD YYYY Grade for the 2025/2026 School Year Knd. 1st 2nd 3rd 4th 5th 6th List any allergies, dietary restrictions, or anything else that we should know about your child If you are finished registering, please scroll to the bottom of this page and click the SUBMIT button. Child #4 Child's Name First Name Last Name Gender Male Female Date of Birth Month/Day/Year MM DD YYYY Grade for the 2025/2026 School Year Knd. 1st 2nd 3rd 4th 5th 6th List any allergies, dietary restrictions, or anything else that we should know about your child Payment $25 per child $ Thank you for registering your child(ren) for SMM Vacation Bible School! You will now be redirected for payment. Counselor's Name * First Name Last Name Counselor's Email * Counselor's Phone Number * (###) ### #### School for the 2025/2026 School Year * Grade for the 2025/2026 School Year * 7th 8th Freshman Sophomore Junior Senior Other Please list any allergies Do you have any conflicts with the schedule? If yes, please explain. Please select all of the following areas that you would be comfortable working at/with: * Knd. Campers Leading/Assisting the Craft Center Leading/Assisting the Music Center Leading/Assisting the Science Center Leading/Assisting the Snack Center Leading/Assisting the Prayer Center Leading/Assisting the Game Center Leading/Assisting the Story Center Assisting in the Main Office/First Aid 1st-6th Campers No Preference Questions? Comments? Concerns? Parent/Guardian Information Parent/Guardian's Name * First Name Last Name Parent/Guardian's Email * Parent/Guardian's Phone Number * (###) ### #### Thank you!
