Parent/Guardian # 1 *

First Name

Last Name

Parent/Guardian #1 Phone Number *

(###)

###

####

Parent/Guardian #2

First Name

Last Name

Parent/Guardian #2 Phone Number *

(###)

###

####

Are you willing to assist your child's teacher in the classroom? *

Yes

No

Photos of children and youth are occasionally used in internal publications, such as the e-newsletter (no names published). Check this box if you DO NOT give permission for us to use your child/children's photograph within the parish.

I do not give permission

Authorization for Emergency Medical Treatment *

Should a medical emergency arise during my child's participation in a St. George's-sponsored activity, I understand that reasonable efforts will be made to contact me or my designated emergency contact at the phone numbers listed above. If it is believed that my child's life or health could be adversely affected by the delay of that attempt to contact me or my designated emergency contact, I consent to emergency medical treatment for my child in my absence. This authorization extends to my child's participation in any activity sponsored by St. George's Church, Arlington, VA.

I consent to the Authorization for Emergency Medical Treatment

I DO NOT consent to the Authorization for Emergency Medical Treatment