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Participant Registration

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Registro en Español

Crossroads Church of the Nazarene

Location

2750 Rogers Avenue

Ellicott City , MD 21043

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Contact Judi Kramer:

410.465.1103

judikramer@crossroadsnaz.org

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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Contact Phone 2

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Text Message Phone

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Home Church Affiliation

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Comments

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Tell Us About Your Participant

Grades K-5: Please select the grade level that your child completed at the end of the 2025-2026 school year.

Preschool: This program is for 4 and 5 year olds who have not yet completed kindergarten. Children must be 4 years old by 7/13/2026.

Nursery: This program is for 0-3 year old children of VOLUNTEERS ONLY.

First Name

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Last Name

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Grade Leaving

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Gender

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Date Of Birth

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I authorize Crossroads to take my child's photographs and to use them on Facebook, Instagram and other social media platforms.

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Allergies

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On Monday, the snack will be clementines

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On Tuesday, the snack will be smiley face sugar cookies (Betty Crocker sugar cookies and frosting, Skittles and Pull and Peel Twizzlers as toppings)

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On Wednesday, the snack will be vanilla pudding cups

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On Thursday, the snack will be pretzel sticks (Snyders) and cheddar cheese sauce

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On Friday, the snack will be rice chex, banana chips, and chocolate chips (Nestle, Hersheys or Great Value from Walmart)

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Medical Concerns

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Does your child have any learning, social-emotional, or behavioral needs that require additional support?

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If yes, please provide details to help us better support them.

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Friend 3 First Name

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Friend 3 Last Name

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Comments

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