Child's Name *

First Name

Last Name

Parent's first and last name *

First Name

Last Name

Phone *

(###)

###

####

Checkbox *

*Note: I authorize medical treatment for my child in case of an accident or illness and the guardian cannot be located. Also, I release BSUMC and directors and volunteers from any and all liability, claims, or demands for personal injury, sickness, or other.

I agree