"*" indicates required fields
Parent/Guardian's Name*
Parent/Guardian's Address*
Parent/Guardian's Phone Number*
Emergency Contact Name*
Emergency Contact Phone*
Please make sure that the emergency contact person WILL BE AVAILABLE from 4:00pm to 5:30pm Wednesdays.
1st Child
Child's Name
Grade —Please choose an option—Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Allergies
2nd Child
3rd Child
We realize that things come up and if you are unable to pick your child/children up, for his/her safety, please supply names of person/people that are allowed to pick up your children:
Name:
Relationship
I hereby give permission for my child/children to attend Valley Bible Church C.E.F. Good News Club. I hereby release Valley Bible Church, Pacific, WA, their staff, leaders, and volunteers from any and all claims and liabilities of whatsoever nature both individually and collectively that may arise from my child's participation in the C.E.F. Good News Club program and activities. I further agree that Valley Bible Church representatives are authorized to seek such medical, dental, surgical care, or treatment as may be necessary for my child during his/her participation in the Good News Club
(*) Denotes required fields
