Registration Form "VBS 2022"

CHILD'S INFORMATION / INFORMACION DEL NIÑO

Full Name / Nombre Completo:

Date of Birth / Fecha de Nacimiento:

Gender/Genero:

F M

Address / Dirección:

Grade completed 2021-2022 school year / Grado Escolar Finalizado 2021-2022

PARENT OR GUARDIAN INFORMATION / INFORMACION DEL PADRE O GUARDIAN

Full Name / Nombre Completo:

Phone

Work Phone / Teléfono del trabajo:

Email:

This address will receive a confirmation email

EMERGENCY INFORMATION / INFORMACION DE EMERGENCIA

=> Emergency Medical Release Form

Special Needs/Medical Concerns/Allergies *

Special Needs/Medical Concerns/Allergies * Please list any special needs, medical concerns, or allergies your child may have, or indicate none.

Other Health Problems / Otro problema de salud:

=> Authorization for Emergency Medical Attention

In the event I cannot be reached to make arrangement for emergency medical care, I am parent/legal guardian, hereby authorize COTRK to secure emergency transportation.

Authorize

Yes No

=> Emergency Contact

Persons to contact in case of emergency if parents are not available / Personas para contactar en caso de emergencia si los padres no responden.

1. Name / Nombre:

Relationship / Relación:

Phone

2. Name / Nombre:

Relationship / Relación:

Phone

I understand that this child will NOT be released from COTRK to anyone except the persons named above. Names can be added or deleted at nay time. This change must be given to the COTRK office staff or child's teacher IN WRITING.

Entiendo que este niño NO saldrá de COTRK con nadie excepto a las personas mencionadas arriba. Los nombres se pueden agregar o eliminar en un cualquier momento. Este cambio debe ser dado al personal de la oficina de COTRK o al maestro del niño POR ESCRITO.

Yes No

=> Consent for Treatment

Parent consent is a legal requirement for treatment of a minor child. To authorize emergency treatment of your child in the event you are unable to be contacted, the following affidavit must be signed. "I am parent/legal guardian, hereby authorize CHILDREN'S MINISTRY CHURCH ON THE ROCK KATY Staff Member to consent to medical treatment of my child, when I cannot be contacted. Such consent includes, without limitation, x-rays, injections, anesthetic, medical, dental or surgical examinations or treatment and or hospital care. No prior determination of life threatening emergency or danger of treatment needs to be made under this Authorization. This authorization remain effective until July 29, 2022.

YES NO

PICTURES AUTHORIZATION

I authorize COTRK Permission to post children's pictures on the website, bulletin, newsletters, or in slideshow of the church. These photos will be used exclusively for the Church and not a copy of them for extortion, disclosure or publication stranger to this institution be shared. El permiso para publicar las fotos de los niños en el sitio web, boletín, boletines de noticias, o en diapositivas de la iglesia. Estas fotos se utilizarán exclusivamente para la Iglesia y no se compartirá copia de ellos para extorsión, divulgación o publicación ajena a esta institución.

Yes No

We are members of Church On The Rock Katy / Somos Miembros de la Iglesia Sobre La Roca, Katy?

Yes No

You want to buy VBS 2022 t-shirt? Quieres comprar la camiseta de la Escuela de Verano 2022? $12

Yes No

Registration Form "VBS 2022"

Description

Please Fix the Following