Academy Cathedral
Vacation Bible School
Child's Information
1st Child
First Name
Last Name
Age
Gender
Please Select
Male
Female
2nd Child
First Name
Last Name
Age
Gender
Please Select
Male
Female
3rd Child
First Name
Last Name
Age
Gender
Please Select
Male
Female
4th Child
First Name
Last Name
Age
Gender
Please Select
Male
Female
Parent/Guardian Information
The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
The parents/guardian listed below will also be the primary emergency contact person.
Name
First Name
Last Name
Relation
Phone Number
-
Area Code
Phone Number
Authorization
I, the parent/guardian of this child/children gives authority to the staff of Musical Hart Evangelistic Association and Academy Cathedral to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
I released the organizers, staff, or managers for any responsibility in case of accident, illness, or injury during my child's enrollment.
I confirm that all information given in this form is true, complete, and accurate.
Parent/Guardian Signature
Submit
Submit
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