Parent/Guardian Name: * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Emergency Contact Name (other than self) * First Name Last Name Emergency Contact Phone Number * (###) ### #### Person(s) other than self authorized to pick up child(ren) * Child 1 Name * First Name Last Name Child 1 Grade (Going into) * Child 1 Allergies (enter N/A if none) * Please check the box below if you give permission for a photo of your child to appear on the church website (or other general photos), as long as there is no identifying information shown I give permission Please enter your initials below if your child may participate in physical activities during gamteimte, and should an injury occur, you will hold harmless from any legal liability, Plumwood Church and any persons involved in the Kids' Ministry I have an more than 1 child * Yes No Thank you!
