Forms

WIRED Swim, Sunglasses & Smile Party!

Please fill out the form for each person attending.
Payment is to be made at the pool the day of the event. $5/person
  • First Name
    Last Name
  • First Name
    Last Name
  • First Name
    Last Name
  • First Name
    Last Name
  • First Name
    Last Name
  • First Name
    Last Name
  • CONSENT -
  • First Name
    Last Name
  •  
  • *I authorize all medical and surgical treatment, X-Ray, laboratory, anesthesia and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment in the event that neither parent/guardian can be reached in the case of an emergency.
    *Attendance at a W.I.R.E.D. event or activity implies permission for Pennsville Baptist Church to record and reproduce my child's name, likeness, and voice in future publicity & promotions.