ILLUMINATION STATION
Kids Week @ West Asheville Baptist
CHILD'S NAME
*
First Name
Last Name
DATE OF BIRTH
*
-
Month
-
Day
Year
Kids must be 4 by 06/15/26 to attend Kids Week. If you are a parent volunteer, childcare is provided for kids under 4.
GENDER
*
Male
Female
LAST GRADE COMPLETED
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Does your child have any allergies or medical conditions we should be aware of?
*
Yes
No
IF YES, PLEASE GIVE MORE DETAIL.
ADDRESS
*
Street Address
Street Address Line 2
City
State
Zip Code
CONTACT NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL
*
example@example.com
Pick Up Authorization
Authorized person/s to pick up your child after Illumination Station
Full Name #1
*
First Name
Last Name
Full Name #2
First Name
Last Name
Full Name #3
First Name
Last Name
Emergency Contact Information
Emergency Contact 1
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact 2
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Social Media Permission
May we have permission to use your child's photograph in WABC's social media? (Names are not shared)
*
Yes
No
Medical Permission
In the event of an emergency, and I cannot be reached, I give permission for WABC Staff to obtain medical treatment for my child if needed. I will pay all costs connected to this treatment.
Medical Permission
*
Yes
No
Electronic Signature
Full Name (Typing your First and Last Name indicates your are completing this form using an electronic signature)
*
Submit
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