Sunnyslope CRC VBS
Parent/ Guardian Name
Primary Phone Number
Alternate Phone Number
Emergency Contact (if different from primary)
Authorized Pick-Up Person(s)
How did you hear about us?
Word of mouth
I know of no mental or physical problems, not listed, which may affect my child's ability to safely participate in this program. I grant permission for my child to be photographed and video/audio recorded in conjunction with these activities/programs. I authorize Sunnyslope CRC's staff volunteers to secure the services of physician or hospital in the event of accident or illness, and I assume responsibility for the cost of these services and will provide repayment of these costs.
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