VBS Kickoff at city park (2021-06-13)

June 13, 2021 @ 6:00 pm – 8:00 pm

2021-06-13T18:00:00-05:00

2021-06-13T20:00:00-05:00

C.A. Thompson Park
101 S Barnwell Ave
Centerville, TN 37033
USA

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
Email
Emergency contact & contact info
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
- No
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
- No
- n/a
Parent/Guardian digital signature & date
CAPTCHA

PERMISSION TO USE IMAGES AND VIDEO