Risingsun First Church of God
7968 U.S. 23, Risingsun, OH 43457
Paul J Rutledge
Easter Egg Hunt 2017
Men's Appreciation Dinner
2017 Corn Hole Tournament
KFC Christmas 2016 The Miracle of Jesus
Hanging of the Greens 2016
Trunk or Treat 2016
Back to School Fair 2016
Cave Quest VBS 2016
Kids for Christ
Vacation Bible School 2017
Vacation bible School Registration
What grade is your child going into?
Jr. High (7th.-8th.)
Emergency Contact & Phone number
Relationship to you?
Medical Authorization To Grant Consent
Dr. Name and number
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by the above name doctors, or, in the event the designated preferred practitioner is not available, by another licensed physician or dentist and the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.
No Refusal to Consent
if you check "no" you are not giving consent for emergency medical treatment
Facts concerning the child’s medical history, including allergies, medications being taken and any physical impairments to which a physician should be alerted.
Church Bus Authorization
If Yes- List Allergies, Medications being take.
Do You need Transportation
If yes, please fill out the location for pick up and drop off
Location for bus pick up
Location for bus drop off
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