Vacation Bible School Registration (1 per child)
July 25th through July 29th
6pm to 8pm
Crossroads Assembly of God Church, 7 DAlfonso Road, Newburgh NY 12550
Contact: CrossroadsAOG.VBS@gmail.com 
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Email *
Name of Child  (one per form) *
Age *
Date of Birth
MM
/
DD
/
YYYY
Street Address (City, State, and Zip Code)
Parent/caregiver's cellphone number *
Email *
Dietary Restrictions/Allergies (Please write "none" if your child has no allergies) *
Emergency Contacts *
Additional Information
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