VBS 2026 registration

Wild Wild West Jefferson VBS sponsored by several community churches. At Harvest Chapel Across from the High School - June 22 - June 25, 2026 from 6pm until 8pm.
preK-6th grade

* Indicates required field

Name of Child attending *

Birthdate *

Gender *

Male Female

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Name *

First

Last

Email *

Home/Cell Phone *

Work Number *

In case of emergency *

First

Last

Relationship to Child *

Emergency Phone Number *

Who can pick up your child? *

Medical concerns *

Food allergies *

Comment *

Last school grade completed *

Name of home church *

Submit