Clone of CBC Tallula #2024BC

Household Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Alternate Guardian #1

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Alternate Guardian #2

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.

Medical Information
Please list all allergies -- or type "none" if there are none
Do any of your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)
Please list all medical concerns -- or type "none" if there are none
Additional Information
Church event photos/videos are taken for promotional purposes related to Calvary Baptist Church and Vacation Bible Camp. These pictures may appear in various media outlets such as our facebook page and webpage. Do you allow your child to be included in these photos/videos?

By submitting this form, I ackowledge I have read and understand the above information.
Signature
Should be Empty:

CBC Tallula #2026BC