_{Pre-register by July 12th to receive 5 VBS BUCKS to spend}

_{in our VBS store!}

Please fill out the form below and then bring your child(ren) before 6:15 p.m. on Monday, July 13, 2026 for the opening day. Pick-up is at 8:15pm Monday, Tuesday, & Thursday and 8:30pm on Wednesday & Friday. The children will be waiting inside the church for their rides to arrive. Please come in and give the staff your child's name!

Any questions, please contact us: The main church line #570-879-4676,

or e-mail Jen Seamans:  fbchallsteadpa.socialmedia@gmail.com

Information given is for the use of First Baptist Church of Hallstead PA only and will not be disclosed to others.

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*

Email Address*

Birthday*

Month Day Year

MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day01020304050607080910111213141516171819202122232425262728293031 Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926

Age as of July 12, 2026*

5

6

7

8

9

10

11

12

Name of Parent or Guardian*

Phone # of Parent or Guardian*

Emergency Contact: Name and Phone #

Church that you regularly attend

Invited by:

Food Allergies/Medical Concerns

Pictures will be taken for social media. Names will not be included in social media posts. Do we have your permission to post photos to our social media account?*

Yes

No

List any children you invited to attend. Children earn VBS Bucks for bringing visitors.

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