VBS • Crossroad Lutheran Church

Family VBS Registration Form - Camp Firelight (July 28, 29, 30 / 5:30 pm - 7:30 pm)

Parent's First Names *

Parents Last Name *

Mobile Number *

Email Address

Mailing Address *

Mailing City *

Mailing State *

Home Zip Code *

Child's Name *

Child's Date of Birth *

Child's Age *

Last Grade Completed *

Any special health concerns: (allergies, restricted activities, medications, etc.)

Emergency Contacts: *

Tip: Please list name(s) & contact information

Photo Release Y/N *

Tip: Crossroad Lutheran Church has my permission to use my child(ren)'s photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.