Arts Adventure
Name of Participant (first and last) *
Your answer
Age and Grade of Participant *
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Participant's School *
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Participant is: *
Name of Parent/Guardian *
Your answer
Email Address *
Your answer
Home Telephone *
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Home Mailing Address *
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Emergency Contact Name and # *
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Name and Numbers of Other People Who Are Allowed to Pick the Participant Up From the Program. *
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Doctor Name and # *
Your answer
MSI *
Your answer
Any Allergies or Intolerances *
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Does the Participant Carry an Epi-Pen? *
Is the participant on any kind of medication? (Wolfville Baptist Church and its staff/volunteers will not be responsible for administering medications.)
T-Shirt Size (for costume) *
Your answer
Precautions will be taken for the safely and health of your child, but in the event of accident or sickness, Wolfville Baptist Church, their staff and volunteers are hereby released from any loss, personal injury, misfortune or damage to the named participant on this form of his/her property. In the event that your child requires special medication, x-rays or treatment, the parent/guardian will be notified immediately. I agree to this statement: *
I give my permission for staff and/or volunteers of Wolfville Baptist Church to take pictures/video of my child(ren) for the purpose of promoting ministry programs within Wolfville Baptist Church *
Church Affiliation (if any) *
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