Please fill out this form once per child if you have multiple children to register

If your child has allergies or any medical conditions we need to be aware of please provide as much detail as possible. You may also choose to provide your childs Health Card information to expediate care in the event of an emergency when health care records may need to be referenced.

I am the legal guardian of the child with full authority to make decisions with respect to the care, upbringing, and education of the applicant.

I agree and comply that all of the medical information provided on this form is true and accurate - lacking nothing. I hereby release my child to the care and medical discretion of the church and volunteers.

New Life Baptist Church and volunteers. In the event of an emergency and that no one can be immediately contacted, my child will be taken to the hospital or a physician to be treated if deemed necessary by church staff or volunteers. I hereby authorize the physician and nursing staff to undertake examination, investigation and neccessary treatment of my child.