Please check the appropriate box

Please include at least one number where we can contact you in case of emergency

Please list any allergies or other medical conditions that may be relevant or state 'none' if not applicable.

This information is helpful as we plan future camps.

If you are already connected with a church, we'd love to know.

As the parent and/or legal guardian of the child named above, I do hereby consent to the participation in the 2020 Emmanuel Baptist Summer Mini Camp. (Please type your name below)

As the parent and/or legal guardian of the child named above, I do hereby authorize the leadership of Emmanuel Baptist Church to care for the administration of first aid treatment for any minor injuries my child may receive during the event. If the injury sustained is life threatening, or in need of emergency treatment, I authorize the leadership of Emmanuel Baptist Church to summon any or all professional emergency personnel to attend, transport and treat my child. I agree to hold harmless any staff, assistants, and volunteer workers of Emmanuel Baptist Church from any and all claims, suits, and actions of any kind whatsoever, arising from their exercise of the power granted by this authorization. (Please type your name below)

I hereby consent to the use of photographs or video recordings of the above listed child by Emmanuel Baptist Church for use on the church web-site or other publicity/electronic/digital/print media, and/or any promotional material.(Please type your name below)

If someone else other than the child's mother/father/guardian will be picking them up after the VBS is finished at any time during the week, please indicate below the name of that person and authorize that person to do so by typing your name in the space below.