Wednesday Nights at Glendale

Childs Name

Child Birthday

Grade

Child 2 Name

Child Birthday

Grade

Child 3 Name

Child Birthday

Grade

Child 4 Name

Child Birthday

Grade

Child 5 Name

Child Birthday

Grade

Parent or Guardian Names

Address

Phone

Church Bus/Van Transportation

Glendale Baptist Church will provide the use of its church bus and vans to pick up and drop off children within the city limits of Booneville, Arkansas. We will not allow any child who currently has to sit in a booster or car seat. The age limit is 17 years of age.

Will your child/children be riding any of our vans or bus?

Yes No

What street address or location will they need to be picked up at before church? (Answer none if you plan to drop off your child.)

What street address or location will they need to be dropped off at after church? (Answer none if you plan to pick up your child.)

In case of emergency contact (someone other than the parent)

Name

Phone

Allergies

Does your child/children have allergies? Please include food allergies.

Yes No

If yes which child and what are they allergic to?

Medical Release

By saying yes I release the adult sponsor and Glendale Baptist Church from responsibility for accidents during church sponsored activities. In case of emergency I give permission to the adult sponsors of Glendale Baptist church to secure proper treatment for he health and comfort of my child until I can be reached.

Yes No

Photo Release

By saying yes I give permission to Glendale Baptist Church to photograph my child. I give permission to copyright, use and publish the photographs for any lawful purpose, including newspaper articles, the church website and social media.

Yes No

Description

Wednesday Nights at Glendale are for any child from kindergarten through age 17. Vans will pick up children and take them home, within the city limits of Booneville.

Wednesday Nights at Glendale

Description

Please Fix the Following