First Church of the Nazarene
Saturday, October 21, 2017
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
 
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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