2019 Vacation Bible School Registration

PARENT NAME
Parent EMail
Home Address
Phone
City
Zip Code
Church Affiliation
Emergency Phone
PERSONS AUTHORIZED TO PICK UP CHILDREN
Name
Authorized Person Phone Number
Relation to Child/Children
Alternative Person Name
Alternative Person Number
Alt Person Phone
Alt Person Relation to Child
SPECIAL NEEDS
HAS SPECIAL NEEDS..NAME.. TALK TO ME
MEDICAL CONSENT. In order to meet legal requirements, I hereby authorize Crossroads Presbyterian Church VBS staff to administer any and all necessary medical care while my child/children are in there custody
signed____________________________  Date___________________________

VIDEO RELEASE
I hereby give Crossroads Presbyterian Church permission to use photographs, video and audio of my child participating in our Vacation Bible School. This media is to be used only on the Crossroads-pc.com web site on a page requiring a password for the purpose of promoting Vacation Bible School and letting the members see all the activities in which the children are involved.
Agreed and accepted by_____________________________Date___________________
REGISTER ALL INDIVIDUAL FAMILY MEMBERS BELOW. CHILDREN FIRST, THEN TEENS AND ADULTS

PARTICIPATING PARENT NAME
A PARENT OR GUARDIAN MUST PARTICIPATE in the Adult program in order to register children 0-3 years old in the nursery

NURSERY (birth through 3 years)

Nursery Child Name & gender
Nursery Child Birthday
Nursery Child Allergies
2nd Nursery Child Name/Gender
2nd Nursery Child Birthday
2nd Nursery Child Allergies
CHILDREN
(Already 4 years old; Beginning Kindergarten to beginning 5th Grade August 2019)
Child number 1 Name / Gender
child number 1 Grade just completed
Child number 1 birthday
Child Number 1 allergies
Child Number 2 Name/Gender
Child Number 2 Grade just completed
Child number 2 birthday
Child Number 2 allergies
Child Number 3 Name & Gender
Child Number 3 Grade just completed
Child number 3 birthday
Child Number 3 allergies
Child Number 4 Name & Gender
Child Number 4 Grade just completed
Child number 4 birthday
Child Number 4 allergies
Child Number 5 Name & Gender
Child Number 5 Grade just completed
Child number 5 birthday
Child Number 5 allergies
TEEN
(Beginning 6th grade through 12th Grade in August 2019)
Parent (of TEEN) Name
Teen number 1 Name & Gender
Teen number 1 Grade just completed
Teen number 1 birthday
Teen number 1 Email
Teen Number1 allergies
Teen number 2 Name & Gender
Teen number 2 Grade just completed
Teen number 2 birthday
Teen number 2 Email
Teen Number 2 allergies
Teen number 3 Name & Gender
Teen number 3 Grade just completed
Teen number 3 birthday
Teen number 3 Email
Teen Number 3 allergies
Teen number 4 Name & Gender
Teen number 4 Grade just completed
Teen number 4 birthday
Teen number 4 Email
Teen Number 4 allergies
ADULTS
(phone and address if different from the first page)

Adult 1 Name
Adult 1 Email
Adult 2 Name
Adult 2 Email
Adult 3 Name
Adult 3 Email
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Service Times & Directions

Weekend Masses in English

Saturday Morning: 8:00 am

Saturday Vigil: 4:30 pm

Sunday: 7:30 am, 9:00 am, 10:45 am,
12:30 pm, 5:30 pm

Weekend Masses In Español

Saturday Vigil: 6:15pm

Sunday: 9:00am, 7:15pm

Weekday Morning Masses

Monday, Tuesday, Thursday & Friday: 8:30 am

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6654 Main Street
Wonderland, AK 45202
(513) 555-7856