Child's Name *
Street Address *
Street Address, Line 2
City *
Zip Code *
Gender * MaleFemale
Date of Birth * ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---12345678910111213141516171819202122232425262728293031 ---2002200320042005200620072008200920102011201220132014201520162017201820192020
Last Grade Completed * ---Not in SchoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Kids T-Shirt Size * ---XSSMLXLXXL
School *
Medical Instructions/Allergies
Parent/Guardian Name *
Parent/Guardian Email
Mobile Phone *
Other Phone
Church You Attend
Emergency Contact Name *
Emergency Contact Phone *
Adult Authorized to Pick up Child
I hereby give my permission for my child to participate in VBS. I authorize the staff of Crossmark Church to obtain emergency medical treatment for my child if he/she becomes ill and I am unable to be contacted. * I agree
I understand that I or an authorized adult must be present at check-in and dismissal every day of VBS, for the safety of my child. * I agree
I hereby authorize Crossmark Church to use photographs and videos of my child for publicity and promotional purposes which include, but are not limited to, in-house presentations, church websites, brochures, and newsletters. Children's names and other personal information are never used without specific permission. * I agree
How did you hear about VBS? * ---EmailFrom a friendA church memberWebsite