2017 VBS Registration
Child's First Name
Your answer
Child's Last Name
Your answer
Child's Gender
School Child Attends:
Child's Grade (in 2017-2018 school year):
If "Other" above:
Your answer
Church Attended (optional):
Your answer
Parent/Guardian Name:
Your answer
Address:
Your answer
Home Phone #:
Your answer
E-mail:
Your answer
Emergency Contact Name:
Your answer
Emergency Contact #:
Your answer
How did you hear about us?
Please include comments or any other information we need to know:
(medical conditions, activity restrictions, etc.)
Your answer
Do you agree to the consent statement below?
I give my permission for my child named above to participate in Vacation Bible School July 17-21, 2017 at Crossroad Baptist Church, and to engage in all Bible and recreational activities that are involved. I agree to be responsible for the expense of medical aid where not covered by the accident insurance policy held by Crossroad Baptist Church. I also understand that if my child must be sent home because of disciplinary or other problems, I will assume all responsibility for the transportation.
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