Vacation Bible School Registration-- Emeral Crossing 2026

Child(ren's) Name

Age(s)

Address

Parent/Legal Guardian Information

Parent/Guardian Name

Home Phone

Cell Phone

Parent/Guardian Email

Emergency Contact if Parent/Guardian cannot be reached

Emergency Contact Phone

Helpful Information

Allergies and Health Concerns:

Other information regarding your child that would be helpful for counselors/teachers:

Home church

Name of friend you would like to be in a group with

Waiver

As the parent/legal guardian of this child(ren), I give permission for him/her to participate in Vacation Bible School at Harlem Reformed Church. I agree

As the parent/legal guardian of this child, I release Harlem Reformed Church, their staff and volunteers from any liabilities that could result from unintentional accidents and/or self inflicted harm. I agree

As the parent/legal guardian of this child, I give permission for the use of photographs in which they are included for church publicity. I agree

Signed

Date

Description

Please fill out this form and click submit.

Vacation Bible School Registration-- Emeral Crossing 2026

Description

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