Child's First Name
Child's Last Name
Grade Leaving Younger - staff children only 4-year old 5-year old Kindergarden 1st grade 2nd grade 3rd grade 4th grade
Address
City Shoreline State WA Zip 98133
Contact phone number xxx-xxx-xxxx Child's Birthdate January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996
Parent or Guardian
Alternate phone (ex. parent's cell) xxx-xxx-xxxx Email parentname@someplace.com Emergency Contact Name Who we call if we can't reach you Emergency Contact Phone xxx-xxx-xxxx
Medical Alerts Parent Approval (required)
I hereby give approval for my child to attend the Shoreline Covenant Church Vacation Bible School and to participate in all activities. I authorize emergency medical care when deemed necessary. I also provide SCC with my authorization to use photos of my child for church ministry programs, brochures and websites (no identifying information will be listed with photos).
I Agree
Shoreline Covenant Church