Wooddale Church Walk in VBS Registration Form

[Pages:1]Wooddale Church Walk in VBS Registration Form

PARENT INFORMATION

Parent's Names:____________________________________________ Address:_________________________________________________ City:__________________ State:______ Zip Code:_______________ Home Phone:__________________ Cell Phone:__________________ E-mail:______________________________________________________ Home Church:________________________________________

Child # 1 qBoy qGirl Birthday ____/____/_____

Full Name:________________________________________________ Age:_____ Grade Completed:_____ Friend Request:______________ Special Needs/Allergies:_____________________________________ _________________________________________________________ OFFICE USE Group Assignment:_______________________________

Child # 2 qBoy qGirl Birthday ____/____/_____

Full Name:________________________________________________ Age:_____ Grade Completed:_____ Friend Request:______________ Special Needs/Allergies:_____________________________________ _________________________________________________________

OFFICE USE Group Assignment:_______________________________

Child # 3 qBoy qGirl Birthday ____/____/_____

Full Name:________________________________________________ Age:_____ Grade Completed:_____ Friend Request:______________ Special Needs/Allergies:_____________________________________ _________________________________________________________

Continued... OFFICE USE Group Assignment:_______________________________

Wooddale Church Medical Release for Summer Day Camps

I hearby give permission for the indicated children to attend summer camps at Wooddale Church, 6630 Shady Oak Road, Eden Prairie, MN 55344 OR Wooddale Church Edina, 5532 Wooddale Avenue South, Edina, MN 55424, 952-944-6300. In the event of an emergency in which my child is in need of immediate hospitalization, medical attention or surgery, and after reasonable efforts have been made to contact me or my spouse and we cannot be located, the purpose of consenting thereto, consent for the emergency attention may be given to any person standing in loco parentis to my child. I understand that my own medical insurance will be the primary coverage.

Parent Signature:_________________________________________ Date:___________

Emergency Information

Emergency Contact:________________________________________ Phone:________________________ Physician's Name:________________________________________ Health Insurance Firm:_____________________________________ Policy Number:___________________________________________ Name Policy is under:_____________________________________ Current Medications:______________________________________

Office Use Only Entered? q

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