Name______________________________ Grade Entering____ School______________

Address_________________________ City__________________ State___ Zip_______

Phone (___) ____-_______ Home Church______________________________________

Parent/Guardian Name_____________________________________________________

Relationship___________________________ Cell Phone_________________________

Emergency Contact_________________________ Phone_________________________

Allergies________________________________________________________________

I agree to allow my child to participate in the activities associated with Jammin’ Jam Fest for Jesus.

The event will be held indoors and outdoors at the Chester First Christian Church.

Outdoor activities may be moved to the Chester City Building in the case if inclement weather.

If activities are moved to the Chester City Building I give permission for my child to

 be transported by personal vehicle or church vehicle to and from that location.

Activities may include but are not limited to inflatable bounces, dunk tanks, chalk art, crafts,

cornhole, mission projects, dinner and a concert.

 I will not hold liable Chester First Christian Church, her members,

 her volunteers or any other participants for any accidental injury.

I agree to come in to the church to pick my child up at the end of the day!

Parent/Guardian Signature________________________________________________