CalvaryAG VBS
Emerald Crossing VBS Registration
Parents Name (1st)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parents Name (2nd)
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Name
First & Last Name
Age
Child's Birthdate
-
Month
-
Day
Year
Date
Child's Name
First & Last Name
Age
Child's Birthdate
-
Month
-
Day
Year
Date
Child's Name
First & Last Name
Age
Child's Birthdate
-
Month
-
Day
Year
Date
Child's Name
First & Last Name
Age
Child's Birthdate
-
Month
-
Day
Year
Date
Emergency Contact
First Name
Phone Number
Secondary Emergency Contact
Full Name
Phone Number
Type a question
Seasonal Allergies
Food allergies
Physical Impairments
Please List:
Type a question
I agree to have my child's picture taken and shared on church website or social media
I DO NOT agree to have my child's picture taken and shared on church website or social media or any other reason
I agree to have my child's picture taken but not shared on social media or church website (ie: only shared during media presentation at church but not online)
I agree to have my child's picture taken for craft/take home souvenir ONLY
My child has
siblings attending VBS. Their names are:
blank
.
Should be Empty: