Child's Name *

Street Address *

Street Address, Line 2

City *

Zip Code *

Gender * MaleFemale

Date of Birth *

Last Grade Completed *

Kids T-Shirt Size *

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

Adult Authorized to Pick up Child

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? *