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I also understand that my child s picture may be taken and used for promotional purposes. Parent/Guardian Signature Date Encounter Grade 11 12 Student Ministry Willingdon Church 4812 Willingdon Avenue Burnaby BC V5G 3H6 p 604. 435. 5544 f 604. 435. 1186 Pastor Jesse Criss jcriss willingdon.org Grade School Birthdate // Gender M / F mm / dd / yyyy Address City Postal code Home Phone Student Email Allergies/ Medical Conditions Care Card Number Emergency contact name number Please turn over. In...
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