CROSSROADS PRESBYTERIAN CHURCH
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VBS Registration 2023
Keepers of the Kingdom: Standing Strong in the Battle for Truth
FAMILY VBS Registration Form
June 12-16, 2023 7:00-9:15 PM Lite Dinner: 6:15 PM
Parent Name
*
Parent Name
First
First
Last
Last
Address
*
Address
Address
Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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New Hampshire
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New York
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Ohio
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Emergency Phone
*
Persons Authorized To Pick up Child/Children
Name Of Person Authorized to Pick Up Child
Name Of Person Authorized to Pick Up Child
First
First
Last
Last
Relation To Child/Children
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Remove
My Child/Children have special needs. Please talk with me.
List all Special Needs
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Name
Name
First
First
Last
Last
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/teen is/are in their custody.
Text
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 website 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.
Text
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