Student's First Name
Student's Last Name
Student's Current Age
Current School Grade
City, State, Zip
Emergency Contact & Phone (if different from above)
Known allergies, conditions being treated for (with corresponding medication name if applicable).
Publicity Release: I grant to First Presbyterian Church Holt the right to take photographs of the above-enrolled student in connection with FPC-Holt church school activities. I agree that First Presbyterian Church of Holt may use such photographs with or without the student's name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above.
By selecting "yes," I am agreeing to the release statement above.
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