Capitol Hill Baptist Church

CDO Registration Form

Gender*

Address*

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My child is...

Mark all that apply.

i.e., biting nails, finger sucking, tantrums, etc

Would you be interested in substitute teaching?

Child's Address*

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Address of Insurance Company*

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In the event of illness or accident which requires immediate medical treatment at a time when a parent cannot be located, I give my permission for the C.D.O. Staff at CHBC to provide such emergency treatment to the best of their ability. I will not hold the C.D.O. Staff of CHBC nor medical personnel responsible. I understand my child will be taken to the nearest emergency facility and I give my permission for the medical personnel to provide emergency treatment. This is done with the understanding that every attempt will have been made to contact a parent, the child's physician, and other persons listed above for emergency contact.

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