Wonder Junction at Christ Community of Hampshire County

Family Information

Address

Street

Street 2

City

State/Province

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Primary Phone

Alternate Phone

Emergency Contact

Relationship to Student

Phone Number

Photo Release Do you grant permission for photos / digital images to be taken of your child (ren) during VBS to be used for crafts and/ or our video recap?

Yes

In the event of an emergency or a non - emergency situation requiring medical treatment, I (type name below) hereby grant permission for any and all medical and/ or dental attention be administered to listed participant(s) until such time as I can be contacted. This permission includes, but is not limited to, the administration of first aid, the use of an ambulance and administration of anesthesia and/ or surgery under the recommendation of qualified medical personnel. Emergency Treatment Consent

Details

Guardian Name

Register for VBS

at Christ Community of Hampshire County

Family Information

Address

Student Information