2026 VBS Emerald Crossing Registration Form for Children

Child ages 5 - 12

Name

Age

Allergies

Parent

First Name

Last Name

This address will receive a confirmation email

Phone

Address

Emergency Contact

Emergency Contact Number

Permission to photograph child and post on West Wyomissing Chapel

Yes No

At the end of VBS each day will your child be walking?

Yes No

Description

Please fill out this form and click submit.