Harvest Life International Church

HARVEST LIFE BUS MINISTRY

(2yrs and under must be accompanied by a legal guardian)

Parent or Legal Guardian's First Name

Last Name

Relationship
Father Mother Legal Guardian

1st. Child's Name

Date of Birth / Grade

2nd. Child's Name

Date of Birth / Grade

3rd. Child's Name

Date of Birth / Grade

4th. Child's Name

Date of Birth / Grade

Address 1

Address 2

City

State

Country

Zip/Postal Code

Cell

Work

Does your child have any medical issues we should be aware of?

I give permission for the above child(ren) to ride Harvest Life International Church's bus and to attend all services/events.
I Agree