Child's Last Name:  Child's First Name:

 

Age:  Date of Birth (mm/dd/yyyy)

Child's Grade (Fall, 2009) (If child is under the age of five, leave blank)  Sex(M-male; F-female):

Child's Address:

City/Sate     Zip:

Parent/Guardian's Name (First and Last):

Parent/Guardian's Home Phone:   Cell Phone:

Persons to be contacted in case of emergency:

 

1. Name (First and Last) Phone:

Relationship to child:

2. Name (First and Last) Phone:

Relationship to child:

 

Does your child have any medical conditions that we need to be aware of? If so, list below

 

Siblings who will also be attending VBS:

 

I give permission for my child to participate in the above named activity and release First Baptist Church, its officers, employees, and agents from any liability whatsoever for any injury or death to person or loss or damage to property sustained by my child or any member of my family, in attendance, and I agree to defend and indemnify First Baptist Church, its officers, emplyees, and agents from any liability or loss they might sustain by reason thereof.

 

Click below to submit this form.  We will keep this form on file for you to sign when you present your child for attendance at RODEO ROUNDUP! "Wanted: Kids After God's Own Heart" VBS at First Baptist Church of Flowery Branch, Ga. on June 6th. We'll look for you, Pardner!