+WNY Coptic H.S. Convention 2019+
~Dates: May 17th, 18th~

~~"But you, O Lord, are a shield for me. My glory and the One who lifts up my head." -Psalm 3:3~~

*Please fill out this form with your parent/guardian*

First Name *
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Last Name *
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Birthday *
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Grade (Currently in) *
Church *
Shirt Size *
Parent Name *
Your answer
Parent Number *
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Emergency Contact Name *
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Emergency Contact Number *
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Any Allergies? (If none, type N/A) *
Your answer
Any Medical Conditions we should be aware of? (If none, type N/A) *
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By signing this I, parent/guardian of (your childs name) give permission to my child, to participate in this convention through the church. (2) I agree that my child will abide by all the rules and regulations of the activity and the instructions of the activity leaders; otherwise, he/she may be returned home. (3) I permit the Church, the activity leaders, or whom they may designate, to act on my behalf in case of medical emergencies pertaining to my child, during the activity. (4) I authorize the medical doctor or hospital to act as they see fit to treat my child in case of emergencies; I will be responsible for the cost of the treatment. (5) I release the Church, priest, directors and members as well as the activity leaders from all liabilities or responsibilities that may arise from events during the activity. (6) I understand that the cost of this convention is $120 and I will give the payment to the servant/priest in my church. *Parent/ guardian, please type out name as a signature to the above statement.* *
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