Crossroad Community Church - VBS Registration (July 10-11-12-13), 6:00pm to 8:00pm, Crossroad Community Church)
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Last grade completed *
Parent/Guardian(s) *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
Email *
Your answer
Emergency Contact Name (other than parent) *
Your answer
Emergency Contact Number *
Your answer
Special Needs / Allergies
List others whom your child can be released to. *
Please be aware that a photo ID will be required to check out your child from Vacation Bible School. First Name / Last Name / Phone Number
Your answer
Photo Release *
I give permission for individual or group photographs, video footage, or sound recordings of the CHILD NAMED ABOVE to be used by Crossroad Community Church for historical and/or promotional purposes and in publications, including, but not limited to, Crossroad Community Church’s website, church bulletin boards, and other Crossroad Community Church publications.
RELEASE: Submitting this on-line form will be the equivalent of signing a paper registration form. *
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