High Power Soccer Camp VBS Registration
Sponsored by Central United Methodist Church
Child's Name
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Address
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Email
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Age
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Grade (2017/18 School Year)
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Child's T-Shirt Size
Church your family attends (if any)
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Parent/Guardian (Name & Phone)
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Emergency Contact (Name, Phone, Relationship)
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List all allergies:
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Person responsible for picking the child up daily: (Name & Phone)
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Insurance Company
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Health Insurance Policy Number
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Preferred Hospital
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Doctor (Name & Phone)
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Please sign and date electronically: I hereby authorize adult workers to secure medical or dental care; which may include but is not limited to ambulance, x-rays, examination, anesthetic, medical or surgical diagnosis, in the event of illness or injury while under the supervision of Central United Methodist Church staff or youth workers. In which case, I shall pay for all such expenses and will in no way hold Central United Methodist Church or its representatives responsible for any financial obligation.I understand that at this event, my Child may be photographed. I agree to allow my Child's photo to be used for any legitimate purpose by the event holders, organizers and assigns. When an identification of a child is made, only the first name of the child may be used along with the name of the church.
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