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Registracion del Participante

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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

Primero, cuéntenos sobre usted:

Información de los Padres

Nombre

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Apellido

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Correo Electrónico

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Dirección 1

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Dirección 2

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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Teléfono de Contacto 1

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Teléfono de Contacto 2

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Mensaje de texto Teléfono

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Nombre del Contacto de Emergencia

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Relación del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Nombre de recogida alternativo

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Teléfono de recogida alternativa

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Afiliación de la iglesia local

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Comentarios

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Cuéntanos sobre tu participante

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.

Nombre

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Apellido

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Grado Saliendo

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Género

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Fecha de nacimiento

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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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Alergias

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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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Preocupaciones Médicas

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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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¿Tienes amigos con los que te gustaría estar juntos? Haremos todo lo posible para juntar a los amigos seleccionados en el mismo grupo, pero no podemos prometer que todas las solicitudes serán posibles.

Amigo 1 Nombre

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Amigo 1 Apellido

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Amigo 2 Nombre

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Amigo 2 Apellido

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Amigo 3 Nombre

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Amigo 3 Apellido

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Comentarios

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