Register your child for 2022 VBS today! Please enable JavaScript in your browser to complete this form. - Step 1 of 3Child's Name *FirstLastParent/Legal Guardian's Name *FirstLastEmail *Cell Phone *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextChild's Birth Date *Child's Age *Child's Completed Grade *Does your child have any food allergies? *YesNoPlease list all food allergies here: *Does your child have any physical limitations or special needs? *YesNoPlease tell us what physical limitations your child has or what their special needs are? *PreviousNextOn occasion, Crossroads Worship Center takes photographs or makes an audio or video recording of children and/or adults involved in activities. Such Photographs or video records may be used by staff and participants to remember the activities and participants. In addition, such photographs and audio-visual recordings may be used in other publications or posts such as Facebook. *I give Crossroads Worship Center permission to use my child's image as stated above.I do not give Crossroads Worship Center permission to use my child's image as stated above.I have read and understand what is required for the Water Sports and I authorize my child to participate in the Water Sports. [During water sports throughout the week, each child must: 1. Wear a bathing suit (one-piece for girls) or dark clothing, 2. Wear water-shoes (or sandals that can get wet), 3. Bring a change of clothes, and 4. Bring a towel. This is required for all children who wish to participate in water activities. Children with Special Needs: Please contact Pastor Matt Mangano for a special needs form and to plan the appropriate modifications to accommodate your child. Note: Participation is pending the outcome of a prior interview.] *Yes, my child can participate in water gamesNo, my child cannot participate in water gamesBy my signature below I testify that I am the legal Parent, or legal Guardian, and consent to my child's participation in this year's Kids' Week VBS at Crossroads Worship Center located at 190 Lambs Rd, Sewell NJ. I also hereby release and forever hold harmless Crossroads Worship Center, located at 190 Lambs Rd, Sewell, NJ, its staff, leaders and agents from any and all liability resulting from injury, illness, loss or damage which may occur to my child while using the facilities or participating in Crossroads Worship Center's activities. *Clear SignatureSignatureRegistration Fee after July 14th *Price: $ 5.00PreviousCommentSubmit
