| St. John's |
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For rising 3rd, 4th, & 5th Grade |
| June 16 - 19, 2008 |
| 9:00 AM - 12:00 PM |
| Fee: $10.00 per Child |
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| Parental
Information |
| Parent(s) Name: |
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| Scheduled Service Projects |
| June 16: Plan for the car wash, cook & pack for soup kitchen |
| June 17: Travel to Washington Street Soup Kitchen to work |
| June 18: car wash at the church to raise
money for to raise money for Hefer International |
| June 19: travel to Harvest Hope for tour and to work |
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| E-Mail Address: |
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| Daytime Phone:
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| Evening Phone: |
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| Cell Phone:
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Address:
(street, city, state, zip) |
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| Emergency Contact Person: |
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Phone Number: |
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| Family Doctor: |
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Phone Number: |
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| Child Information
Add
a Child Remove
Checked Children |
1) To enroll
a child, enter information below.
2) To enroll additional children, click 'Add a Child' above.
3) To remove a child from your list, click in the box 'Remove Child'
on the far right
and then click 'Remove Checked Children'
above.
4) When you have read and agreed to the Medical Release below, click
'Continue'.
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Medical & Liability Release - Valid from June 16 - 19, 2008
In the event of sickness or some medical emergency, I request that
my child receive any medical attention or treatment deemed necessary,
therefore I give permission to any hospital, doctor, and/or health
care provider authority to transport, treat and/or admit for care
my child. I understand that I am responsible for all expenses and
charges for the treatment and care of my child. In the event that
I am not present at the time of the emergency or cannot be contacted,
my care has been entrusted to the staff and designated ministry
leadership of St. John's Episcopal Church. |
| I Agree to the above Medical
& Liability Release :
Date:
(mm/dd/yyyy) |
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:: visitors
