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Fort Bayou Family Church - Vancleave
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Child Name (
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Age (
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Grade completed this year (
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Email address (
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Shirt size (
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Does your child take medication (
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Does your child have any food or medication allergies? (
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Emergency Contact Name (
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Emergency Contact Phone Number (
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I can pay summer camp fee (
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I need assistance paying for camp (
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I have read and acknowledge consent form (
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By filling out this form, as the parent/guardian, I understand that reasonable precautions will be taken to safeguard the health and well-being of this child during any church event, and that I will be notified as soon as possible in the event of an emergency. In case of sickness or an accident, I authorize and consent to Fort Bayou Family Church, or other associated volunteers to obtain medical care from a licensed medical professional, hospital, or medical clinic for the child described above, if myself or other legal guardians cannot be reached. I do hereby release and forever discharge Fort Bayou Family Church, and other associated volunteers from all manners of actions, claims, which I or the child shall or may have for any reason, arising during the child’s attendance during church functions, on or off of the church premises. Unless other written instruction is submitted, I also consent to allowing the child’s image to be recorded, either by photograph or video for publicity.
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