Child Participation and Release Form
Thank you for involving your child in FBC Lebanon!
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Email *
Parent/Guardian #1: Name *
Street Address, City, State, Zip *
Parent/Guardian #1: Phone Number *
I agree to receive group information texts and e-mails from First Baptist Lebanon *
Parent/Guardian #2: Name
Parent/Guardian #2: Phone Number
Parent/Guardian #2: E-mail Address
Emergency Contact: Name & Phone Number of person other than Parent/Guardian #1 or #2. In case of emergency we will try to call parent/guardian(s) first. *
Child #1: First & Last Name (Preferred Name) *
Child #1: Grade for the 2023-2024 School Year *
Name of School Attending (if applicable)
Child #1: Date of Birth (mm/dd/yyyy) *
Child #1: Please list any handicaps/medical conditions/allergies, etc. that we need to be aware of
Child #2: First & Last Name (Preferred Name)
Child #2: Grade for the 2023-24 School Year
Child #2: Name of School Attending (if applicable)
Child #2: Date of Birth (mm/dd/yyyy)
Child #2: Please list any handicaps/medical conditions/allergies that we need to be aware of
Child #3: First & Last Name (Preferred Name)
Child #3: Grade for the 2022-24 School Year
Child #3: Name of School (if applicable)
Child #3: Date of Birth (mm/dd/yyyy)
Child #3: Please list any handicaps/medical conditions/allergies that we need to be aware of
Child #4: First & Last Name (Preferred Name)
Child #4: Grade for the 2023-24 School Year
Child #4: Name of School (if applicable)
Child #4: Date of Birth (mm/dd/yyyy)
Child #4: Please list any handicaps/medical conditions/allergies that we need to be aware of
Child #5: First & Last Name (Preferred Name)
Child #5: Grade for the 2023-24 School Year
Child #5: Name of School (if applicable)
Child #5: Date of Birth (mm/dd/yyyy)
Child #5: Please list any handicaps/medical conditions/allergies that we need to be aware of
Child #6: First & Last Name (Preferred Name)
Child #6: Grade for the 2023-24 School Year
Child #6: Name of School Attending (if applicable)
Child #6: Date of Birth (mm/dd/yyyy)
Child #6: Please list any handicaps/medical conditions/allergies that we need to be aware of
What is the name of the church you currently attend (if not FBC Lebanon)?
How did you hear about FBC Lebanon?
Other questions or comments you have for the church?
RELEASE FORM                                                                                                                My child has permission to attend activities and daily child care programs with First Baptist Church, Lebanon, TN, ("FBC"). I understand that FBC will take all reasonable steps to provide individual care and safety for my child.     *I am aware that the FBC or their employees or agents cannot assume any responsibility for an injury, damage or harm which may result during the course of any activity during functions so sponsored. In consideration of permitting my child to participate, I agree that full responsibility will remain with me, as parent or guardian of my child. Should any claim be asserted by any person as the result of the acts of my child while participating in the course of activities provided by FBC, or traveling to or from such activity, or should my child assert any claim against FBC or its employees or agents, I agree to indemnify and hold FBC harmless from any such claim, including attorney fees and costs incurred by FBC in defense thereof.  I recognize that all FBC staff and volunteers are mandatory reporters of any suspected physical or sexual abuse.                                                                                                 *I agree to receive church e-mails and texts to stay up to date on information and that I may opt out at any time.                                                                                                 *I understand that as a participant, I or my child may be photographed or videotaped during normal event activities, and these photos/videos may be used in promotional materials.                                                                                                          *I grant permission for my child to ride in FBC-owned vehicles or in a private vehicle with a responsible adult who has been approved by the ministry staff of FBC.                                                                                                                                  *I further authorize medical treatment of my child in the event of illness or injury sustained in my absence while my child participates in the course of activities provided by FBC.
Parent/Legal Guardian Signature *
Questions/Comments
A copy of your responses will be emailed to the address you provided.
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