Vacation Bible School Registration Form
Register your child for our exciting week of faith and fun, and let us know if you'll join the Family Day celebration.
THE ROCK CHURCH BROCKTON
VACATION BIBLE SCHOOL 2026
📅 July 8–10, 2026
🕓 4:30 PM – 7:30 PM
📍 74B Plain Street, Brockton, MA
👧🧒 Ages: 6–12 Years Old
💲 $20 per child
🍎 Snack and Light Meal Included
Family Day – Friday, July 10: Parents/guardians are invited to a special session and celebration!
Child’s Full Name
*
First Name
Last Name
Child’s Age (must be 6–12)
*
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Additional Siblings
Sibling's Name
Sibling's Age
Sibling's Name
Sibling's Age
Sibling's Name
Sibling's Age
Are there any allergies, medications or health concerns we should be aware of?
In case of a medical emergency I give The Rock Church permission to seek medical attention on my child's behalf (CPR, etc)
*
Yes, I give permission
Who will be picking up your child / how will your child get home?
Health insurance info in case of an emergency (Insurance Name and Group #)
Emotional or social concerns we should be aware of?
Who will attend Family Day on Friday, July 10? (Please list names of parents/guardians and any siblings or guests)
I give permission for The Rock Church of Brockton to take photos and videos of my child and to use them on the church website and social media pages.
*
Yes, I give permission
Vacation Bible School Registration Fee
*
prev
next
( X )
Vacation Bible School Registration (per child)
Covers all three evenings, activities, and meals.
$20.00
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Register
Should be Empty: