2017 Clearbranch VBS Registration
Who is Registering?
First Name
Your answer
Last Name
Your answer
Grade Completed
Mailing Address
Your answer
zip code
Your answer
Parent Cell Phone
Your answer
Parent email
Your answer
Insurance Provider
Your answer
Policy Holder
Your answer
Any allergies or conditions
Your answer
Liability Information
The Staff and Volunteers of Clearbranch UMC have my permission to seek medical care for my child(ren) in the case of an injury or accident. We will make every effort to contact you, but in the event I cannot be reached, the medical professionals have my permission to treat my child(ren) as deemed necessary.
I have read and agreed to the above stated conditions for my students participation.
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