Keepers of the Kingdom, VBS 2023 (2023-06-11)

Date & Time:

June 11, 2023 @ 5:30 pm – June 14, 2023 @ 8:00 pm

2023-06-11T17:30:00-05:00

2023-06-14T20:00:00-05:00

Location:

Cross Roads Baptist Church
181 W Beaverdam Rd
Centerville, TN 37033
USA

Contact:

Diane Woerner

Register me for Keepers of the Kingdom VBS 2023! (1)

Cross Roads Baptist Church VBS registration

Name

First Last

Gender

Birth Date

(M/D/Y)

Age

Grade Completed

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian

First Last

Phone

Emergency contact & phone #

Emergency contact's relationship to child

Who is authorized to pick up your child

Name of home church

Allergies/Medical concerns

PERMISSION TO USE IMAGES AND VIDEO

I hereby grant permission for Cross Roads Baptist Church to record sounds, images, or video of my child

Yes

I also give permission for Cross Roads Baptist Church, at it's sole discretion, to use these sounds, images, or videos in publications (church website/social media platforms owned by the church).

Yes

n/a

Parent/Guardian digital signature & date

CAPTCHA