VBS Registration Form | Faith Baptist Church

( One form per child, please )

Child's Name *

Birthday *

Street Address *

Apartment

City *

State *

Zip Code *

Consent *

My child(ren) may be photographed and/or video recorded. I understand that their picture might be posted on Faith Baptist Church's Facebook page., website and social media platforms

Emergency Contact Information

Relationship to child *ParentGuardian

Name *

Home Phone *

Cell Phone *

Other Phone *

If we are unable to contact you in an emergency, who else may be contacted?

Name

Relationship to child

Phone 1

Phone 2

Name anyone who is restrained from picking up this child

Liability Release

I, the parent(s) and/or legal guardian(s) of the child(ren) listed above, hereby request permission for this child to participate in any and all of the activities of the Faith Baptist Church of Milton, Florida, Vacation Bible School. I do hereby further generally, fully, completely and absolutely hold harmless the Faith Baptist Church of Milton, Florida, including, but not limited to, all board members, sponsors, employees, leaders, volunteer drivers, and chaperones, from any and all liability of any kind or nature whatsoever. In case of injury to my/our child, I hereby waive all claims against the parties set forth above, and further agree to fully indemnify and hold said parties harmless from any liability whatsoever. I likewise release from responsibility any person transporting my/our child to or from activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. Taking into account the subjects age, I believe that the subject of this release is physically and mentally capable of taking reasonable precautions to protect his/her own safety and has the maturity and judgement not to put himself/herself or others in dangerous situations.

I consent to the above Liability Release

Any pre-existing medical conditions, disabilities, or physical handicaps

Name of any prescription medications (including dosage and frequency) child is taking

If my child is in pain and if deemed advisable by a supervisory adult, I grant permission for the following non-prescription medication to be given

Acetaminophen *YesNo

Ibuprofen *YesNo

Please list any allergies child has

Please list any physical restrictions child has

In case of medical or surgical emergency, I hereby request and give permission to the Faith Baptist Church for the hospitalization and/or provision of necessary medical treatment. I understand that I am responsible for the cost of any medical treatment (including surgery) received by my child(ren). I hereby release the directors and staff of this event from all resposibility for sickness or accidents which occur during the event. I understand that I will be contacted immediately in the case of an emergency.

Please Understand that, depending upon the seriousness of the situation, your child may be transported to the nearest hospital.

Please verify that all information is correct and current *

Checking this box indicates that the reader agrees to all stipulations set forth above.

Digital Signature *Considered Legal Signature