Childs Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name *

First Name

Last Name

Parent Phone *

(###)

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Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

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Parent(s)/Guardian(s) Signature(s) *

By checking this box, I give permission for my child to attend and participate in Vacation Bible School at Harvest Christian Fellowship July 29-Aug 2, 2024. I also give permission to seek whatever medical attention is deemed necessary, should the need arise, and I release Harvest Christian Fellowship and its staff of any liability against personal losses of named child/children.