“For nothing is impossible with God.” Luke 1:37

P.O. Box 115028 * Atlanta, GA 30310
(678) 754-7700 * info@thelukeproject.org
www.thelukeproject.org

Screen Shot 2016-08-23 at 10.26.35 AMCityJam…dynamic worship, dance and drama connecting youth to Christ
Tuesday Evenings 5:30 – 7:30 p.m. for students ages 7-15

 

 

This permission slip covers children who attend CityJam via walking, van, car or bus. Note: Students are required to wait outside of The Luke Project’s building until class begins and will need to be picked up at the conclusion of class each day. Van riders will be picked up and dropped off per the van route and schedule. Call 678-754-7700.

 

Parents, please see monthly calendar for an up to date schedule of events.

CityJam...dynamic worship, dance and drama
Child’s Name
Age
Grade
Birth date
Home Phone
Parents’ Names (Father)
(Mother)
Child’s Address
Apt. #
City
Zip Code
Parents’ Work Phone (Father)
Parents’ Work Phone (Mother)
Emergency Contact Name
Emergency Contact Phone
Relationship of Emergency Contact to child
Family Doctor Name
Family Doctor Phone
Family Medical Insurance Company | (If your child’s healthcare is provided though Medicaid, Peach Care or other please write that in the blank.)
Policy of Group Number or Medicaid / Peach Care ID - Other Number
Date of last Tetanus Inoculation | (If this is unknown, write “unknown” in the blank.)
Any known allergies or food allergies
Any additional medical information that we need to be aware of
I am sending the following medicine or medical equipment with my child
I (print parent’s name) have read, agreed to, and support The Luke Project policies. I give my permission for the staff and volunteers of The Luke Project to work with my minor child in accordance with policies described herein, including seeking medical treatment in the case of an emergency.
Parent/Guardian’s Signature
Sending