BLAST Registration and Permission Form
Junction's First Baptist Church
(Believe Learn and Seek Truth)
202 S 8th St/P.O. Box 51
Junction, TX, 76849
(325) 446-2125
jfbc2125@gmail.com

One form per child

Bus Rules:
1: You must stay seated at all times
2: You must keep your hands and feet to yourself at all times
3: Only appropriate and kind language!
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Child's Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade *
Allergies *
Parent/Guardian Name *
Address (City and Zip) *
Cell Phone *
Email *
Home Church *
Phone Number to reach you during BLAST hours (5:30-7:30pm) *
Emergency Contact (if guardian cannot be reached) *
Emergency Contact Phone Number *
Physician's Name *
Physician Phone Number *
I hereby give my permission for my child to attend and participate in the Junction's First Baptist Church BLAST Programs and any special activities and events planned by JFBC BLAST. I do hereby authorize emergency treatment to be given, if necessary, only after a reasonable effort has been made to reach me, the parent/guardian. I also agree to release and hold harmless the BLAST leadership and JFBC for any and all liabilities or claims for personal injury which may be incurred by my child while attending and participating in the JFBC's BLAST Program and its activities and special events. *
I do understand and hereby grant JFBC's BLAST program, its staff and leaders permission, that, while my child is participating in BLAST activities, photographs and videotape of my child may be taken for use in promoting BLAST and its activities within JFBC. I further release JFBC and its staff and leadership from any and all claims that I may have against them as a result of my child's picture being used in promoting BLAST with JFBC. *
Health Concerns/Conditions *
Special Instructions *
How will your child get home? *
Required
People who CAN pick up your children
Parent/Guardian Electronic Signature (Please include date) *
Submit
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