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Parent/Guardian Name *
Parent/Guardian Name
List full name and age of child attending.
Emergency Contact Info
In case of emergency, I give permission to the representatives of Word & Worship Church to obtain medical treatment for my child in my absence.
Date of Birth
Date of Birth
Emergency Contact Phone
Emergency Contact Phone
Photo/Video Release *
I authorize that my child’s image may be photographed or filmed and be used in video, print, or web presentations.