VBS 2018 - Passport to Peru
Event Timing: June 25th-June 29th
Event Address: 2151 N. Palo Verde Blvd, Tucson, AZ 85716
Contact us at (520) 327-6233 or Email office@bookoflifecc.com
Parent/Guardian Name (First & Last Name) *
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If NOT Parent/Relationship *
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Address *
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State *
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Zip *
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Home Phone *
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Cell *
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Parent/Guardian Email *
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Emergency Contact Name *
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Phone *
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Relationship to child *
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Name of Child
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Age
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Gender *
Name of Child
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Age
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Gender *
Name of Child
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Age
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Gender
Name of Child
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Age
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Gender *
Does your child have any medical conditions that we should be aware of? (Allergies, medications, etc) *
If Yes, please explain & Name Child
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Medical Release: I (We), the parent(s) or guardian(s) of the above listed child(ren) grant permission for our child(ren) to participate in Vacation Bible School at Book of Life Community Church and Congregation Beth Sar Shalom and to receive medical treatment if necessary. If I (we) or the listed child care provider or emergency contact cannot be reached, I (we) give our permission to the staff to secure the services of a licensed physician to provide necessary care for my child’s well-being. I (we) also release and agree to hold harmless Book of Life Community Church and Congregation Beth Sar Shalom and all its participants from any liability and assume all risk of injury, damage or expenses as the result of participation in activities in Vacation Bible School. Photo Release: I (We) understand that as a participant in Book of Life Community Church and Congregation Beth Sar Shalom VBS, my child(ren) may be photographed or videotaped during VBS events. I also understand that these may be used in presentation & promotional materials. I release Book of Life Community Church and Congregation Beth Sar Shalom from any and all liability. *
Parent/Guardian Signature *
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