"Love God, Love People, Make Disciples"
Mid-Week Bible Study
What We Believe
Allergy(s) &/or Medical Condition
Mother’s Name & phone
Father’s Name & phone
Emergency contact Name & phone
Who is authorized to pick up your child at dismissal?
I grant permission (check each box)
Authorization to publish pictures(without names)on website and other publications
In the event of illness or accident, I give permission for first aid to be administered where considered necessary by a person trained in first aid, if available, or medical treatment to be administered by a suitably qualified medical practitioner. I agree that neither Neapolis Church of Christ nor its volunteers assume any legal liability for injuries or other losses.
If I cannot be contacted and my child should require emergency hospital treatment, I authorize an adult leader to sign on my behalf any written form of consent required by the hospital. I understand that every effort will be made to contact me as soon as possible. I, the parent, assume all financial responsibility.