BUDDY WEEK
BUDDY WEEK
Vista Member: __________________________________________________ Class: ______________________________________
(Print full name) (Day) (Time)
Buddy’s Name: ____________________________________________________________________________ Age:_____________
(Print full name)
Address: ________________________________________________________ City/Town: ________________________________
(Street)
Postal Code______________________ Phone: ________________________ Email:_____________________________________
Medical Condition or allergy: __________________________________________________________________________________
Parents name(s)________________________________________________ Signature ___________________________________
(Print full name)
Emergency contact: Name_________________________________________________ Phone______________________________
(Print full name)
(Print full name) (Day) (Time)
Buddy’s Name: ____________________________________________________________________________ Age:_____________
(Print full name)
Address: ________________________________________________________ City/Town: ________________________________
(Street)
Postal Code______________________ Phone: ________________________ Email:_____________________________________
Medical Condition or allergy: __________________________________________________________________________________
Parents name(s)________________________________________________ Signature ___________________________________
(Print full name)
Emergency contact: Name_________________________________________________ Phone______________________________
(Print full name)
| Form must be returned the week before buddy week |
BUDDY WEEK
| MON JUN 4 to SUN JUN 10/2012 |