Year A Advent IV

12/19/2016

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Clearances required by PA state law for all volunteers

Child's Name *

First

Last

Child's Birthday *

Guardian's Name #1 *

First

Last

Guardian's Name #2 *

First

Last

Guardian's Primary Email *

Guardian's Phone Number *

Primary Address *

Line 1

Line 2

City

State

Zip Code

Country

Check if participating *

Godly Play Junior Acolytes Children's Chapel Parent Volunteers

Photo Release *

Yes, pictures of my child may be used for parish publications No, photos of my child may not be used for parish publicatoins

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