Name of child(ren)

Parent or Legal Guardian:

Address:

Age(s)

Emergency Contact Person (other than parent)

Allergies (especially food allergies)

The fee is $1 per day per child, not to exceed $10 per family. If this fee would be a hardship for your family, please indicate so by typing "request fee cancelled" in the box below. (This will be kept completely confidential)

Other Helpful Information (illnesses, medication, activity restriction, etc.)

Phone Number:

Email address (for registration confirmation):

Phone Number:

The fee will be collected at the start of the first day.

Crosswinds Presbyterian Church
20125 N. 15th Avenue
Phoenix, AZ 85027
(623) 582-2018

Vacation Bible School Registration Form
August 2-6, 9:00 a.m. to 12:00 p.m