VBS Registration | POK SDA CHURCH

Date and Time: July 13-17, 2026, 9am-3pm each day.

Location: Poughkeepsie SDA Church, 71 Mitchell Avenue, Poughkeepsie, NY 12603.

Age Range: For ages 5-12, and for ages 13-15.

Please fill out the form for each child you register. If you have any questions, email hello@poksdachurch.org.

Parent / Guardian's Information

PARENT/GUARDIAN'S FIRST NAME:

PARENT/GUARDIAN'S LAST NAME:

MOBILE/CELL NUMBER (Include the area code):

HOME/OTHER NUMBER (Optional):

PARENT/GUARDIAN'S EMAIL ADDRESS:

HOME ADDRESS (STREET):

CITY/TOWN:

STATE:

ZIP CODE:

SPOUSE/OTHER GUARDIAN'S FULL NAME (Optional):

RELATIONSHIP TO PARENT/GUARDIAN (Optional):

PHONE NUMBER FOR SPOUSE/OTHER GUARDIAN:

DO YOU BELONG TO A CHURCH?

YES

IF "YES", PLEASE WRITE THE NAME OF YOUR CHURCH: (If not, please write NA)

Child's Information

CHILD'S FULL NAME (First & Last Name)

GENDER:

DATE OF BIRTH:

GRADE IN THE FALL:

DOES YOUR CHILD HAVE ANY ALLERGIES? [If not, write NA]:

CONSENT: I give consent for my child to be photographed and/or videotaped during VBS activities.

YES

ADDITIONAL COMMENTS? Is there something you would like us to know?

ADDITIONAL CHILDREN TO REGISTER? (Please fill a separate form per child)

YES

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