Medical Consent For Kid’s Oasis
Community Presbyterian Church
Celebration, FL

Child's Name (required)

Birth Date (required- if your browser does not display a drop down calendar, enter yyyy/mm/dd)

Current Grade

Parent/Guardian Name(s) (required)

Your Email (required)

Address (required)

Cell Phone (required)

Emergency Contact (required)

Relationship to Child

Phone (required)

Medications/Allergies?

By typing your name below, you confirm that all information you've submitted is true and that you agree to the terms of this Medical Consent Form.

Parent/Guardian Signature

Date (required- if your browser does not display a drop down calendar, enter yyyy/mm/dd)

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