Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Authorized to pick up student If other than someone already listed on the form, please list name and phone number of anyone else authorized to pick up your student.

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Home Church

I hereby grant permission for Cross Roads Baptist Church to record sounds, images, or video of my child

I also give permission for Cross Roads Baptist Church, at it's sole discretion, to use these sounds, images, or videos in publications (church website/social media platforms owned by the church).

Parent or guardian typed signature

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

I have more students to register