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
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
Child (1) Birth Date
Medical/Health/Allergy Concerns (1)
Child (2) Name
Child (2) Age
Child (2) Grade
Child (2) Birth Date
Medical/Health/Allergy Concerns (2)
Child (3) Name
Child (3) Age
Child (3) Grade
Child (3) Birth Date
Medical/Health/Allergy Concerns (3)
I give permission for my child(ren) to be picked up by: