Work Entry

Emmanuel Evangelical Free Church

Student Annual Waiver - Student Information

Information received is confidential and is being gathered for the purposes of serving your student while in the care of Emmanuel Evangelical Free Church. Any Medical information collected here serves to authorize Emmanuel Evangelical Free Church, and its staff and volunteers, to obtain medical assistance in emergencies.

First Name

Last Name

Date of Birth

Gender

School Grade

Home Address

Phone

E-Mail

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