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VBS 2024 Registration
For Children entering Pre-K to finishing 5th Grade
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* Indicates required question
VBS is Scheduled for
Friday, June 7 (6:00-8:00PM)
Saturday, June 8 (9:00AM-2:00PM)
Sunday, June 9 (10:30AM-2:00PM)
Name of Child
*
First & Last
Your answer
Grade Completed
*
Select the school grade your child just completed
Choose
Pre-School
Kindergarten
1st
2nd
3rd
4th
5th
School Attended
*
What school does/did your child attend?
Bells Elementary
Alamo Elementary
Gadsden Elementary
Friendship Elementary
Maury City Elementary
Ms. Linda's Daycare
Other:
Home Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Name of Parent or Guardian
*
Your answer
Phone Number of Parent or Guardian
*
Your answer
Name of Secondary Emergency Contact
*
Your answer
Relation of Second Emergency Contact to Child
*
Your answer
Secondary Emergency Contact Phone Number
*
Your answer
Email Address
Your answer
Beside you, please list persons authorized to pick up your child
*
Your answer
Please list any known allergies or medical conditions
Your answer
Special Information about your child
Your answer
What church does your family attend?
Your answer
Would you like more information about Cross Roads Baptist Church?
Yes
No
Not Sure
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