Child's Name:

Child's Age:

Child's Grade Just Completed:

Address:

Home Phone Number:

Mother's Name:

Mother's Work Phone:

Mother's Cell Phone:

Father's Name:

Father's Work Phone:

Father's Cell Phone:

Home Church:

I give my permission (Write YES or NO in the box)

for the above name child to attend Faith Presbyterian Church's Vacation Bible School from 9:00 A.M. until Noon, Monday thru Friday, June 26th thru June 30th, 2017. I shall not hold this church or their staff responsible for any injury that might occur during this time: I agreethat my child may receive care in the case ofv an injuryaccording to the policy of Faith Presbyterian Churchthat might occur during this time SIGN HERE TO AGREEBY TYPING YOUR NAME:.

FAITH PRESBYTERIAN CHURCH POLICY ON Safety of your child/>

Safety of all children participating in one of our ministries is our priority. In the event that a child or youth is injured while under our care, the following steps should be followed:/p> >

1. For minor injuries, scrapes, and bruises, workers will provide First Aid (Band-Aids, etc.) as appropriate and will notify the child’s parent or guardian of the injury at the time the child is picked up from our care./pp

2. For injuries requiring medical treatment beyond simple First Aid, the parent and/or guardian will immediately be summoned in addition to the worker’s supervisor. If warranted by circumstances, an ambulance will be called./

3. Once the child has received appropriate medical attention, an incident report will be completed in the case of injuries requiring treatment by a medical professional

PHOTO PERMISSION

I give my permission (Write YES or NO in the box) for Faith Presbyterian Church to include any pictures of the child named above taken at the Faith Presbyterian Church Vacation Bible School--to be used in any articles or photo displays published by the church--incuding on the church's website:

Does the child named above have any food allergies? If so, please specify:

In case of an emergency, please contact Dr.:

Doctor's Address or Location:

Doctor's Phone:

Your E-mail address:

Transportation Pick-up each day/p> .p One of the parents or guardians listed above will pick up our child from the church each day or list others who are authorized to pick up our child. Electronic Signature (By typing my name in the box that follows, I certify that I am the parent or legal guardian of the child named above (TYPE YOUR NAME) 

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