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Midweek Kids Registration

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Fields marked with an * are required

Student First Name *

Student Last Name *

Student Date of Birth *

Parent Name (First, Last)

Parent Phone Number *

Parent Email Address *

Address 1 *

City *

Zip / Post Code *

Emergency Contact Name/Phone Number (other than parent listed)

Does your child have any allergies or medical conditions we should know about? If so, please list otherwise type no *

By checking box I give my permission for my child(ren) to participate in First Baptist Church’s children's activities. I understand the known risks involved in the program for my child(ren) in consideration of FBC allowing us to participate in the program. I hereby fully release and forever discharge the parties named above, along with heirs, officers, agents, employees, and volunteers. In the event of illness or accident, having parental responsibility for the named child(ren), I give permission for first aid to be administered where considered necessary by a person trained in first aid, if available, or medical treatment to be administered by a suitably qualified medical practitioner. If I cannot be contacted and my child(ren) should require emergency hospital treatment, I authorize an adult leader to sign on my behalf any written form of consent required by the hospital. However, I understand that every effort will be made to contact me as soon as possible. I understand that by my child(ren)’s participation in this church activity his/her picture could be taken and used in press releases, social media, video, websites, etc. for informational use only (ie – Website updates, promotions of events, etc.). In such cases, names will never be listed. *

Please check box if your child needs to ride the church van. I give consent for my child(ren) named above to ride to and from First Baptist Church to participate in church activities. Further, I agree to hold First Baptist Church, its officers, workers or representatives guiltless in the event of accident or injury to my child(ren). I further grant permission for First Baptist Church workers to act on my behalf in the event of accident or injury to my child(ren) provided reasonable effort has been made to reach me.