VBS Registration 2026 "Emerald Crossing"
Please fill out this form and click submit.
Parent/Guardian/Caregiver & Family Info
Parent(s)/Guardian(s)/Caregiver(s) Names
*
Mom's cell
*
Dad's cell
Mom's email
*
This address will receive a confirmation email
Dad's email
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Emergency contact
*
Relationship to Family
*
Emergency Contact Cell Number
*
Who can pick up your child(ren), Please List all
*
Name of home church
Child #1 Info
Child's Name
*
Gender
*
Please select one option.
Boy
Girl
Grade (for the 2026-2027 school year)
*
Please select one option.
Pre K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Birthday
*
Age
*
Food allergies (Skip if N/A)
Medical concerns (Skip if N/A)
Child #2 Info
Child's Name
Gender
Please select one option.
Boy
Girl
Grade (for the 2026-2027 school year)
Please select one option.
Pre k
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Birthday
Age
Food allergies (Skip if N/A)
Medical concerns (Skip if N/A)
Child #3 Info
Child's Name
Gender
Please select one option.
Boy
Girl
Grade (for the 2026-2027 school year)
Please select one option.
Pre K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Birthday
Age
Food allergies (Skip if N/A)
Medical concerns (Skip if N/A)
Child #4 Info
Child's Name
Gender
Please select one option.
Boy
Girl
Grade (for the 2026-2027 school year)
Please select one option.
Pre K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Birthday
Age
Food allergies (Skip if N/A)
Medical concerns (Skip if N/A)
ACKNOWLEDGMENT
Medical Release This release is effective for Vacation Bible School sponsored by Emmanuel Baptist Church. As parent/guardian, I authorize treatment under the direction of any licensed physician for my child(ren) in the event of a medical emergency. This authority is granted only after reasonable effort has been made to reach me by phone. The undersigned assumes responsibility for any costs connected with such treatment and releases Emmanuel Baptist Church from any liability.
*
Please select all that apply.
Agree
Disagree
Photo Release Do you allow Emmanuel Baptist Church to use your child’s photo in our publications (church website, Facebook, etc)? Check box below.
*
Please select one option.
Agree
Disagree
Submit
Description
Please fill out this form and click submit.
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