Grade just
finished:
Allergies or other concerns:
Child’s Name:
Date of Birth:
Shirt Size:
Grade just
finished:
Allergies or other concerns:
Child’s Name:
Date of Birth:
Shirt Size:
Grade just
finished:
Allergies or other concerns:
Consent to Provide Medical Care
I understand that if serious illness or injury occurs, I will
be notified. If it is impossible to contact me, I give permission for
emergency treatment as recommended by the attending physician. I have read
and understand the above information.
Parent Signature will be required on 1st day of VBS.
If you cannot contact me, please contact one of the following
people in case of emergency:
Name:
Phone:
Relationship:
Name:
Phone:
Relationship: