Camp Genesis VBS

April 11, 2008

 

 

Registration for Parent's Night Out at Genesis Community Church

Please feed your children before arriving or bring a sack supper. Snacks will be provided.

Children Information

1st Child's Name
 Age
 Grade
2nd Child's Name
 Age
 Grade
3rd Child's Name
 Age
 Grade
4th Child's Name
 Age
 Grade
Phone Number
Address
City
 State
 Zipcode
E-Mail

Parent / Guardian & Emergency  Information

Mother's Name
 Father's Name
Mother's Cell Phone
 Father's Cell Phone
Does your child have any special needs workers should be aware of? If so, list:

List the names of those who have permission to pick-up your child:

Emergency Phone and Contact if a parent listed above is not available:

 

I hereby give consent for my child to participate in Parent's Night Out. I assume all risk in regard to participation in this event. I release, indemnify and agree to hold harmless Genesis Community Church, it's pastor, elders, members, and volunteers from any liability that may result from participation in the Parent's Night Out which is sponsored by Genesis Community Church.

In the event of a medical emergency, I authorize Genesis Community Church to seek emergency professional medical care for my child as deemed necessary by the Genesis Community Church staff.

Enter "YES" (in all caps) if you  agree to the above statements.

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Woodcreek Bible Church                   Contact Us                  7066 W. Hwy. 66 Royse City, TX 75189-4162                    214.543.9836