2026 VBS Registration Form

Register me for Emerald Crossing!

Child's First Name

Child's Last Name

Gender

Birthday

Grade

Address 1

Address 2

City

State

Zip Code

Parent/Guardian

Parent Phone Number

Parent Email

Emergency Contact Person's First Name

Emergency Contact Person's Last Name

Relationship to child

Emergency Contact Person's Phone Number

Home Church

Food Allergies

Yes

Medical Concern

Yes

Allergies or other medical conditions

Any other comments

PERMISSION TO USE IMAGES AND VIDEO

I hereby grant permission for

to record sounds, images, or video of my child

While attending this VBS program. I also give permission for

at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media plaforms) owned by

in relation to this VBS program.

Date / Time