June 9th 5:30pm
June 10th 8:30am
Parent/Guardian
Phone Number
Parent/Guardian/Emergency Backup
Email
Address
City
Zipcode
Number of Children
Child's Name
Age
Last Grade Completed
Birthday
T-Shirt Size
Please list any allergies or medical conditions we should be aware of while in care of your child
Check this box if you are registering more than 6 children and you will continue by re submitting a new form with the rest of your children.
Consent Form: Consent Form: By checking this box I affirm that: I am the above named parent or legal guardian of the above named child(ren) and I give permission for my child(ren) to attend Vacation Bible School at Crossroads and participate in all VBS activities. I authorize all medical, surgical, diagnostic, and hospital care or procedures which may be performed or prescribed for the above named child(ren) by a licensed physician or hospital, when efforts to contact me are unsuccessful and when deemed immediately necessary or advisable by the physician to safeguard my child’s health. I acknowledge that Crossroads will not be responsible for medical expenses incurred. I give permission for the above named child(ren) to be photographed during VBS, and for the images to be published, reproduced or distributed by Crossroads in all outlets, including, but not limited to, internet and church publications, without liability or limitation on my or my minor’s part. I give permission for the above named child(ren) to be transported by crossroads for VBS activities.
5 + 10 =
