I, the parent and/or legal guardian of the above named minor do hereby appoint Pinecrest ARP Church to act on my behalf in authorizing emergency medical, dental, surgical care and or hospitalization for this child in the event I cannot be reached. I agree to be financially responsible for all treatment. I give permission for my child to be picked up by the persons listed above. I give permission for my child's picture to be used in all Pinecrest ARP Church's publications.

The Vacation Bible School program at Pinecrest ARP Church is provided free of charge.