2025 Reading Buddies Registration Form

Contact

Student Name

Student Birthdate

School Attended

Grade

First Grade Second Grade Third Grade Fourth Grade Fifth Grade

Parent/Guardian Name

Home Address

Phone

Parent/Guardian Email

This address will receive a confirmation email

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Other Emergency Contacts or other information

Please list anyone besides the Parent/Guardian to whom your child can be released

Medical

By signing this section you give permission for First Presbyterian Church to obtain emergency medical treatment for your child, in the very unlikely event that your child needs assistance and a parent cannot be reached.

List Allergies, Medical Conditions and/or Medications (or mark NA)

Please list any other special health, behavioral or physical needs/limitations/special abilities

Physician(s)

Parent/Guardian Signature

Media Release

By signing this, I give permission for photgraphs and videos of my children to be taken and used in print and online media. Children will never be identified in photos online!

Parent/Guardian Signature

Today's Date

Permission

By completing this form, I give my child permission to participate in all regular activities associated with Reading Buddies (including scheduled field trips) during the Summer of 2025.

Parent/Guardian Signature

Today's Date

Description

This form will register your child for the Summer 2025 Reading Buddies program. If you have questions, contact the church and we will gladly give assistance!

2025 Reading Buddies Registration Form

Description

Please Fix the Following