2022 Vacation Bible School Registration

Parent 1 Name

Parent 2 Name

Address

Best Contact Phone

This address will receive a confirmation email

Emergency Contact Name

Emergency Contact Phone

Please add each child and the grade they will be entering in fall 2022.

Child 1 Name

Child 1 Grade

Pre-K K 1st 2nd 3rd 4th 5th 6th

Child 2 Name

Child 2 Grade Pre-K K 1st 2nd 3rd 4th 5th 6th

Child 3 Name

Child 3 Grade Pre-K K 1st 2nd 3rd 4th 5th 6th

Child 4 Name

Child 4 Grade Pre-K K 1st 2nd 3rd 4th 5th 6th

Child 5 Name

Child 5 Grade Pre-K K 1st 2nd 3rd 4th 5th 6th

Allergies/Medical Conditions (please specify which child)

Home Church

RELEASE STATEMENT: In the event medical treatment is required, I understand every effort will be made to contact me (us) by telephone. I (we) hereby give permission to a physician to hospitalize, secure proper treatment for, and to inject, administer anesthesia or perform surgery for the student listed on this form. This medical treatment authorization is good for all Riverwood Covenant Church Children's and Youth events. I (we) agree to indemnify and hold Riverwood Covenant Church, its paid and volunteer staff harmless for personal injuries to others or property damage which result from my (our) son/daughter's participating in the course of activities for all events during 2022. I forever release Riverwood Covenant Church, the staff, the volunteers, and representatives.

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2022 Vacation Bible School Registration

Description

Please Fix the Following