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Jamestown, NY
Mon Jul 15–Fri Jul 19 AT 9 a.m.–noon
Primary Phone
Alternate Phone
Phone Number
Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other
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Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Friend Other
Gender
Birth Date
Age Group
Food Allergies
Details
Medical Concerns
Name and relationship of TWO people other than parents who may pick up your child:
I am this child's parent or legal guardian
Hillcrest has permission to use photographs and recordings of my child.
Hillcrest is authorized to determine medically necessary emergency treatment when advised by a licensed health care professional. I understand that I am responsible for medical bills incurred.
Approved Hillcrest volunteers may assist my child in the restroom if requested. The worker may assist with age-appropriate basic tasks of care & hygiene.
Optional — Please list any special needs for this student (include disabilities):
Special needs/disabilities
Optional — If your child is attending VBS with a special friend, you may list ONE child in the SAME age/grade that you would like to have placed with your child. (We'll do our best to accommodate)
I have more students to register