VBS Registration Form

Use this form to register your kids for CrossWinds 2019 VBS. VBS is June 10-14 from 8:30 to 11:30 a.m. for children aged 3 years to having just completed 5th grade. This form has student information spaces to register up to 6 kids. If you have any questions, please contact Emily in the church office at 712-336-3537 or emily@crosswinds.tv

Question Title

* 1. Student Information

First and Last Name

Birthday

Grade Last Completed

Gender

Allergies/Special Considerations

Notes

Question Title

* 2. Student #2 Information (if applicable)

First and Last Name

Birthday

Grade Last Completed

Gender

Allergies/Special Considerations

Notes

Question Title

* 3. Student #3 Information (if applicable)

First and Last Name

Birthday

Grade Last Completed

Gender

Allergies/Special Considerations

Notes

Question Title

* 4. Student #4 Information (if applicable)

First and Last Name

Birthday

Grade Last Completed

Gender

Allergies/Special Considerations

Notes

Question Title

* 5. Student #5 Information (if applicable)

First and Last Name

Birthday

Grade Last Completed

Gender

Allergies/Special Considerations

Notes

Question Title

* 6. Student #6 Information (if applicable)

First and Last Name

Birthday

Grade Last Completed

Gender

Allergies/Special Considerations

Notes

Question Title

* 7. Parent Information

Mother's Name (First and Last)

Father's Name (First and Last)

Street Address

City

State

Zip Code

Phone Number

Email Address

Emergency Contact Name (First and Last)

Emergency Contact Phone Number

Notes

Question Title

* 8. Pictures will be taken and posted on our Media Pages. Please check no if you are not ok with your Children’s photos being shared.

Yes

Other (please specify)