Summer Teen Rallies

Summer Teen Rallies Permission Slip

Student Name

First Last

Address

Street Address City State ZIP / Postal Code

Grade

Name of Parent or Guardian

First Last

Parent or Guardian Email

Parent or Gaurdian Phone

List any health problems or handicaps

List any drug allergies

List any activity restrictions

Regular Medications

Name of Insurer

Policy and/or group number

Join us every Friday night at 6:30PM for Freedom That Lasts

602.751.7597

Freedom That Lasts

Name*
First Last
Email
Phone
General Information
If you would like, tell us a little about yourself to help us get to know you better.

Northwest Valley Baptist Church Transportation

Child's Name(Required)

First Last

Child's Birthdate(Required)

Child's Grade(Required)

Please enter a number from 1 to 12.

Allergies

Please describe any food allergies the child may have.

Regular Medications

Please describe any medications your child is currently taking.

Pick-up Address(Required)

Street Address City

Drop-off Address(Required)

Same as pick-up address

Street Address City

Contact Information

Home Phone

Cell Phone 1

Relationship to Child

Relationship of person to child with Cell Phone 1

Cell Phone 2

Relationship to Child

Relationship of person to child with Cell Phone 2

Primary Contact(Required)

Parent's or Guardian Information

Parent or Guardian Name

First Last

Address

Same as pick-up address

Street Address City

[give_form id=”490522″]

Parent/Guardian Name*
First Last
Parent/Guardian Email*
Parent/Guardian Phone*
Parent/Guardian Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Church*
How did you hear about VBS*
Parent/Guardian Consent*
Permission Waiver - Please Read
Parent / Guardian Digital Signature - I give my permission for my child named above to participate in Vacation Bible School June 10-14, 2019 at Northwest Valley Baptist Church, and to engage in all Bible and recreational activities that are involved. I realize that photography or videography from this activity may be used in marketing or social media (please communicate with the church office in advance if you would like an exemption). I agree to be responsible for the expense of medical aid where not covered by the accident insurance policy held by Northwest Valley Baptist Church.
Children
Child's Name
First Last
Child's Gender
Child's Grade (Fall 2019)
Child's Birthday
MM slash DD slash YYYY

Child's Medical Conditions / Allergies / Activity Restrictions

[give_form id=”489595″]

Claimed and Unclaimed Compensation