Allergy/Medical/Special Needs Form 2024/25

Please fill out this form and click submit.
We are so glad to have your child and your family be a part of the life and programs at Emmanuel. This form is intended to share information among the volunteers and staff that interact with your child. This information is important and is used carefully, but it isn't intended to be kept confidential. Please be specific about how to best care for your child. Keep in mind that our volunteers are not professionally trained, but want your child to feel that they are in a safe and welcoming environment. You only need to do this once each year - we will do our best to share info between the various programs.
 
 
 
 
 
Please select one option.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Emergency Contact Info
(only one adult's info is required)
 
 
 
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Please select one option.
 
 
 
Please select one option.
Please select all that apply.
Contact information will be used by Emmanuel Barrie for communication regarding this and other events, ministries and programs. Please see our Privacy Policy for more information.

Description

Please fill out this form and click submit.