Family Vacation Bible School 2024
Crossroads Assembly of God Church
615 E. Ash St.
Elmwood, IL.  61529
June 19th - 21st 
6:00-8:30 PM
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Email *
Parent / guardian name, address and phone number. *
Name(s) and phone number(s) of others that are authorized to pick up your child(ren) and their relationship to child. *
Name(s) and age(s) of the child(ren) that will be attending? *
Names of any adult family members that will be attending? *
Does any child(ren) have any food allergies or medical issues that we need to be aware of?  If yes, please provide additional details. *
I consent and give permission for Crossroads VBS directors to seek medical attention on behalf of my child(ren) in the event it becomes necessary. *
Name, address and phone number of child's physician. *
I consent and give release for Crossroads VBS directors and staff to take photos / videos of my child(ren).  I understand that these photos / videos may be used for marketing and promotion and I will receive no compensation for their use.   *
By completing and submitting this form, I acknowledge that I am providing and authorizing all information the same as if I was providing it in person.  *
Date and Name of person completing this form. *
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