✚Emerald Crossing Student Registration

Cross into a summer of faith, friendship, and fun. · 2026

Elementary Middle

Students

Student 1

First Name

Required.

Last Name

Required.

Birthday

Required.

Gender

Required.

Last Grade Completed

Required.

Allergies / Medical Notes

Parent / Guardian

First Name

Required.

Last Name

Required.

Cell Phone

Required.

Home Phone

Work Phone

Address

Address line 1 is required.

City

Required.

State

Required.

Zip

Required.

Emergency Contacts

Contact 1 First Name

Contact 1 Last Name

Contact 1 Phone

Contact 2 First Name

Contact 2 Last Name

Contact 2 Phone

Contact 3 First Name

Contact 3 Last Name

Contact 3 Phone

Additional Info

Guest Of

Comments

✚Emerald Crossing Student Registration

Students

Student 1

Student 2

Student 3

Student 4

Student 5

Student 6

Parent / Guardian

Emergency Contacts

Permissions & Transportation

Additional Info