Cactusville Registration : Kerrville Seventh-day Adventist Church Kerrville TX

Parent/Guardian's Name

Mailing Address

Phone

Home Church

Child 1-Name

Child 1-Age

Last Grade Completed

Child 2-Name

Child 2-Age

Child 2-Last Grade Completed

Child 3-Name

Child 3-Age

Child 3-Last Grade Completed

Child 4-Name

Child 4-Age

Child 4-Last Grade Completed

Allergies

Name of Person Authorized for Pick up? Please include any additional information below

Photographs and/or video will be taken and possibly used for publications related to the Kerrville SDA Church, such as bulletins, newsletters, presentations and website. As a Parent/Guardian, I give permission to the Kerrville SDA Church to photograph and/or record my child/children. According to this Photo/Video Release Statement, I grant permission for my child to be photographed. Select Yes if you agree. Yes No

As a parent/guardian, I authorize the treatment by a qualified doctor of the minor(s) listed in the event of an medical emergency while participating in at the Kerrville SDA Church Yes No

By selecting I DO agree below, I attest that I am the parent/guardian for the child(ren) listed and all information provide above has been answered fully and correctly. I do Agree

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