Register now Child's Name * First Name Last Name Gender Male Female Email * Date of Birth (MM/DD/YYYY) * MM DD YYYY Parent / Guardian's Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Primary Phone * (###) ### #### Secondary Phone (###) ### #### Emergency Contact's Name * First Name Last Name Special needs or allergies Person responsible for pickup after VBS * First Name Last Name Relationship to Child * Their Phone Number * (###) ### #### Photo Release * Cross Roads Community has my permission to use my child's photograph publicly in VBS publications and promotions in print, social media, and online. I also understand that no royalty, fee, or compensation shall become available to me by reason of such use. Yes DO NOT PUBLISH MY CHILD'S IMAGE Thank you!