fakepage - AETNA CALVARY CHURCH

VBS Registration

Child's Name *

Age *

Birthday 01-01-01 *

Grade (this fall) *

Meds/Allergies *

Child's Name *

Age *

Birthday 01-01-01 *

Grade (this fall) *

Meds/Allergies *

Child's Name *

Age *

Birthday 01-01-01 *

Grade (this fall) *

Meds/Allergies *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

The minors listed above have my permission to participate in all 2023 Aetna Calvary Church VBS activities except as noted below. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by Aetna Calvary Church staff to secure and administer treatment, including hospitalization, for my child/children as named above.

Comments/Info: *

Emergency Name and Number #1 *

Emergency Name and Number #2 *

Emergency Name and Number #3 *

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