Under the Big Top VBS 2021 (June 28-30)

Child's Name

Date of Birth

Child's Age as of June 28, 2021

Parent/Guardian Name

Phone

This address will receive a confirmation email

Address

Emergency Contact Name

Emergency Contact Phone

Do you have a church you attend regularly?

Yes No

May we contact you about upcoming events?

Yes, please! No, thank you I already attend Calvary Pentecostal Church

Are there any allergies or other medical information we should know about?

Yes No

If yes, please explain.

Please type your name in the box below agreeing to the following statements. In the event of sickness or medical emergency where I am not present and cannot be reached, I request that my child(ren) receive any medical attention or treatment deemed necessary by the staff and/or ministry leadership of Calvary Pentecostal Church. Therefore, I give permission to any hospital, doctor, and/or health care provider to treat, transport/admit my child. I understand that I am responsible for all expenses and charges for the treatment and care of my child. I also give permission for pictures and video of my child to be used on any of Calvary Pentecostal Church's in-and-out of house publicity.

Description

June 28-30 6:00-8:30 PM

Calvary Pentecostal Church
6811 Woolworth Road
Shreveport, LA 71129

Under the Big Top VBS 2021 (June 28-30)

Description

Please Fix the Following