Registration Child's First & Last Name: Date of Birth: Grade (as of fall 2012): Allergies: Parent's First & Last Name: Address: City: State: ZIP: Emergancy Phone Number: Email: Medical Release I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. If I cannot be reached, I authorize Second Baptist Church to transport my child to the nearest care facility. I also authorize the performance of medical, minor surgical, or diagnostic procedures, including the administration of local anesthesia that may be deemed necessary or advisable by the attending physician or surgeon in the diagnosis and emergency treatment of my son or daughter in the event that I cannot be reached for direct authorization. Photo Release Second Baptist Church may have opportunities to publicize and promote its Vacation Bible School program to church members and to the public. In such case, photos, but no names, would be used. I give Second Baptist Church permission to include my child/children in publicity and promotional materials.