Calvary Kids Club Form | Calvary Central

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Students Name:

First

Last

Date of Birth

Grade:

Health Name: Permission

School:

Ocotillo Elementary

Parent or Guardian

Phone:

Email:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Name:

Emergency Contact Phone:

Relationship

After the Club (Please select one):

I will pick up my child
My child has permission to bike/walk
Have my child return to after school program

Other option:

Other Adults Authorized to pick up my child:

(Parents/Guardians are respsonible for their child’s safety from the time the child leaves the school/park until the child reaches home.)

Health Concerns/Known Allergies of my child:

List or put none.

I give permission for images of my child to be captured during Calvary Kids Club through video, photo and/or digital camera, to be used solely for the purposes of promotional material and publications.

No. I do not.
Yes, I do.

Parental/Guardian Permission & Agreement

I agree and give my permission

By completing this form, you are granting permission for your student to attend Calvary Kids Club.