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Learn More
About Us
Staff
Service Times
This Week
Ministries
Men
Ladies
Students
Children
Music
Media
Missions
Events
Watch
Messages
Testimonies
Music
Contact
Child
Registration
Child's Name
*
First Name
Last Name
Parent/Legal Guardian Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
*
(###)
###
####
Cell Phone
*
(###)
###
####
Child's Birthdate
*
MM
DD
YYYY
Last Grade Completed
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Does child attend Sunday School?
*
Yes
No
If so, where?
Food Allergies?
*
In case of emergency, whom do we call?
*
First Name
Last Name
Emergency Contact Phone Number
*
(###)
###
####
Who may pick up this child?
*
I need transportation to and/or from VBS.
*
Yes
No
Parent/Legal Guardian Signature
*
This acts as a digital signature.
Date Signed
*
MM
DD
YYYY
Medical Release Form
Child's Name
*
I, the undersigned parent or legal guardian of the below mentioned child, a minor, do hereby authorize adult volunteers of First Baptist Church as agent(s) for the undersigned to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability First Baptist Church including any of its ministers, leaders or volunteers in the event of an accident enroute, during or returning from the above-mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence.
First Name
Last Name
Date Signed
*
MM
DD
YYYY
Parent/Legal Guardian
*
First Name
Last Name
Parent/Legal Guardian Signature
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Phone (Home)
*
(###)
###
####
Emergency Phone (Work)
*
(###)
###
####
Health Insurance Company
*
Policy or Group Number
*
Does your child have any medical or special needs, including medications currently being used.
*
Yes
No
If yes, please explain.
Doctor's Name
*
Doctor's Phone Number
*
(###)
###
####
Dentist's Name
*
Dentist's Phone Number
*
(###)
###
####
Date of last tetanus shot
*
MM
DD
YYYY
Thank you! If you would like to register another child, please click
here
.