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By signing my name below, I do hereby authorize the Woodstock Evangelical Covenant Church to seek emergency medical care for my child(ren) in the event of injury, accident or illness. I give my son/daughter permission to attend the Hayride event with the WECC on October 21, 2018 for Sr. High and October 24, 2018 for Jr. High.

Parent's Name (required)

Street Address (required)

City/State/Zip Code(required)

Phone Number (required)

Parent's Email (required)

Emergency Contact Name 1 (required)

Emergency Contact Phone 1 (required)

Emergency Contact Name 2 (required)

Emergency Contact Phone 2 (required)

Insurance provider and number(required)

May we have your permission to photograph your child(ren)? (required)
YesNo

Child (1) Name

Child (1) Age

Child (1) Grade

Medical/Health/Allergy Concerns (1)

Child (2) Name

Child (2) Age

Child (2) Grade

Medical/Health/Allergy Concerns (2)

Child (3) Name

Child (3) Age

Child (3) Grade

Medical/Health/Allergy Concerns (3)

 

By signing my name below, I do hereby authorize the Woodstock Evangelical Covenant Church to seek emergency medical care for my child(ren) in the event of injury, accident or illness. I give my son/daughter permission to attend the Reverb Event in Providence, RI with WECC November 16-17, 2018

Parent's Name (required)

Street Address (required)

City/State/Zip Code(required)

Phone Number (required)

Parent's Email (required)

Emergency Contact Name 1 (required)

Emergency Contact Phone 1 (required)

Emergency Contact Name 2 (required)

Emergency Contact Phone 2 (required)

Insurance provider and number(required)

May we have your permission to photograph your child(ren)? (required)
YesNo

Child (1) Name

Child (1) Age

Child (1) Grade

Medical/Health/Allergy Concerns (1)

Child (2) Name

Child (2) Age

Child (2) Grade

Medical/Health/Allergy Concerns (2)

Child (3) Name

Child (3) Age

Child (3) Grade

Medical/Health/Allergy Concerns (3)

Payment

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