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Participant Registration

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Crossroads Church of the Nazarene

Location

2750 Rogers Avenue

Ellicott City , MD 21043

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Contact Gretchen Hand:

410.465.1103

gretchenhand@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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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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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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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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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

Grades K-5: Please select the grade level that your child completed at the end of the 2023-2024 school year.

Preschool: This program is for 4 and 5 year olds who are entering PreK. Children must be 4 years old by 7/01/2024.

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

Allergy Information: All snacks are nut-free. Prior to the start of VBS, our snack team leader will call to clarify details about your child's specific dietary needs.

Medical Concerns: Does your child have an intellectual or physical disability? Prior to the start of VBS, a VBS leader will contact you to clarify details about how to support your child.

First Name

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Last Name

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Current Grade

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Gender

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Date Of Birth

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Medical Concerns

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Allergies

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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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Comments

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