General Information (add additional pages as needed)Child's Name(s) Grade Birthday MM slash DD slash YYYY Child's Name(s) Grade Birthday MM slash DD slash YYYY Child's Name(s) Grade Birthday MM slash DD slash YYYY Child's Name(s) Grade Birthday MM slash DD slash YYYY Parent(s)/Guardian(s) Name(s) Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberEmail Address Medical InformationMedical conditions Please list any medical conditions or allergies, and any medication or special care they require.Other conditions or behaviors we should be aware of, and strategies for assisting Dietary Restrictions: Is your child on a restricted diet? Yes No If yes, please indicate food or beverages your child should not consume. Medical Release - Authorization and Consent of Parent(s) or Legal Guardian(s) As custodian of the aforementioned minor(s), I grant my authorization and consent for a designated adult to administer general first aid treatment for minor injuries or illnesses. If the injury or illness is severe, I authorize him or her to seek professional emergency personnel to attend, transport, and treat the minor and to issue consent for any medical care deemed advisable by a licensed medical professional or institution. I authorize the designated adult to exercise best judgment upon the advice of medical or emergency personnel.Photo Release Hillcrest Baptist has my permission to use my or my child's photograph(s). I understand that the images may be used in Hillcrest Church's print publications, online publications, presentations, website, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.Form Submission Date MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged. Δ