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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