Join us for worship, Sundays at 10:00AM at 4310 Pleasant Valley Rd, Chantilly, VA 20151
Making Christ Known in Northern Virginia

VBS Registration

SHEPHERD GATE CHURCH Vacation Bible School Registration Form

VBS Registration Form 2016

A complete registration must be completed for each child attending. Parents and guardians - fill out your information first. Below that you can fill out the information for your child.


Parent/Guardian's name (required)

Your email (required)

Address-City-State-Zip (required)

Home Phone Number (required)

Work Phone Number

Cell Phone Number

Emergency Contact Name: (required)

Emergency Number: (required)

NOTE: Pre-schoolers must be able to
perform bathroom tasks independently.

Information about your child

Child's name (required)

What grade will your child enter in the fall (required)

Age at time of VBS (required)

Does your child have any allergies?

List Special Instructions for your child?

T-Shirts are included in the cost and guaranteed ONLY if registration and payment are turned in by July 13th.

Indicate T-Shirt size for your child



Photo Permission: I
DoDo Not
give permission for my child to be photographed or recorded during VBS. We present a slide show to our congregation after VBS and also keep pictures in our church year book. Photos may also be posted to our website and Facebook page, though no identifying information will listed. Additionally, photographs may be used in our newsletters and bulletins.


I give permission for my child to attend Shepherd Gate Church’s (SGC) Vacation Bible School (VBS) and all of the activities associated with that week. I hereby release SGC from responsibility and liability for any injury or illness that my child may sustain during this activity. In the event of an emergency, I authorize an adult leader of this activity as an agent for me, to consent to any treatment advised and supervised by a licensed physician. I expect to be contacted as soon as possible.

Clicking on “Send” will serve as your affirmation to the above paragraph and that you believe that all the above information you filled out is true to the best of your knowledge.

Please enter the Captcha code below



We also encourage you to sign up for our newsletter.

You may be curious to know why this form has been made so narrow. It is to make it easier for those with portable devices to fill this out.

Registration Fee: $35 per child.

T-Shirts are included in the cost and guaranteed ONLY if registration and payment are turned in by July 11th. Additional T-shirts are available on request.

Dont’ want to register online?

Please fill out and return this registration form

Not everyone likes online registration and payment.  You can click the link above, print the form, fill it out (one form per child) and mail it to the church office with payment.
Registrations can be mailed or dropped off at:
Shepherd Gate Church
4310 Pleasant Valley Rd Chantilly, VA 20151