First Church of the Nazarene
Saturday, October 20, 2018
Reaching. Fellowshipping. Caring.
Child's Name
Child's Age        Date of Birth           Last grade completed
Name of Parent(s)
Street Address           
City & State                          Zip
Home Phone/Parent/Caregiver cell phone
Allergies or other medical conditions
In case of emergency, contact
Phone                    Relationship to Child
I give my permission for RFC staff to obtain urgent medical care for my child