VBS Registration Form

Hello Adventurers,

It’s a jungle out there! Join us for an epic jungle journey at VBS this summer! Jungle adventures are for ages 4-12 and include:

Rain or Shine Bible Time
Rainforest Recreation Games
Tree-mendous Crafts
Canopy Cafe Snacks
And more!
Time & place:
June 25-27 from 5:00 - 8:00 pm
Southport Baptist Church
755 Bard Rd, Port Hueneme 93060

For questions, contact Pastor Clarence or Susanna at 785-713-1925

For any questions regarding VBS or Southport Baptist Church, please see Contact Information. (Link Below)

Contact Information

Childrens Name(s)

First Name

Last Name

Children(s) Age(s)

Child's Grade

Parent/Guardian Name(s)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Best contact number

(###)

###

####

Emergency Information

Emergency Contact 1

First Name

Last Name

Phone

(###)

###

####

Emergency Contact 2

First Name

Last Name

Phone

(###)

###

####

Doctor's Name & Phone Number

Allergies or Special Needs

Dismissal

Who may pick up your child at the end of each VBS day?

Name & Relationship

Parent/Guardian Authorization

By typing in your name, this constitutes official authorization for child registration, emergency information and dismissal protocols.

Today's Date

YYYY

Pre-Register for VBS 2025

VBS Registration Form