You Are Invited!
3456 Club
Grades 3 - 6
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Water Games
Friday, July 16
6:00 - 10:30 P.M.
Cost: $3
Bring towel & change of clothes. Wear clothes you don't mind getting dirty. Dark colored t-shirts only.
Sign-up in vestibule.
(Must have signed permission slip and emergency medical form. See below.)
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Name: ______________________________________
Address: _____________________________________
Emergency Phone: _____________________________
Authorization for Emergency Care
I give my permission for the above named minor to participate in the Collinsville Baptist Tabernacle 3456 Club activity, Water Games, Friday, July 16 from 6:00 to 10:30 p.m.
I hereby authorize any physician licensed to practice in Oklahoma to provide emergency medical care and give medication to the above named minor, if the need arises. I understand that I and/or my personal insurance will be responsible for any expense incurred.
Signed: __________________________Date:_________
(Parent or Guardian)
Witnessed By: ____________________Date:_________
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