God’s Backyard Bible Club Registration SPRING 2018
Child’s Name *
First & Last, ex: "Parker Bowling"
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade in Spring of 2018 *
School *
Home Address *
Street, City, State, Zip
Your answer
(1) Parent or Guardian Name *
Your answer
(1) Parent or Guardian Home Phone
ex: 828-437-1811
Your answer
(1) Parent or Guardian Cell Phone
ex: 828-437-1811
Your answer
(1) Parent or Guardian e-mail address *
Your answer
(1) Parent or Guardian...I am available Wednesday afternoons to volunteer for God's Backyard Bible Club (even one Wednesday a semester for a few hours is appreciated). *
(2) Parent or Guardian Name
Your answer
(2) Parent or Guardian Home Phone
ex: 828-437-1811
Your answer
(2) Parent or Guardian Cell Phone
ex: 828-437-1811
Your answer
(2) Parent or Guardian e-mail address
Your answer
(2) Parent or Guardian...I am available Wednesday afternoons to volunteer for God's Backyard Bible Club (even one Wednesday a semester for a few hours is appreciated).
Home Church
(1) Emergency Contact Name *
Your answer
(1) Emergency Contact Phone *
ex: 828-437-1811
Your answer
(1) Emergency Contact Relationship to Child *
ex: "Neighbor" or "Grandmother"
Your answer
(2) Emergency Contact Name *
Your answer
(2) Emergency Contact Phone *
ex: 828-437-1811
Your answer
(2) Emergency Contact Relationship to Child *
ex: "Neighbor" or "Grandmother"
Your answer
Does your child have any medical condition(s) (medications, etc.) that we should be aware of?
Your answer
Does your child have any food allergies or other allergies that we should be aware of? *
If so, please list allergies below:
Your answer
(1) Persons other than a parent/guardian permitted to pick up my child (I.D. required):
(include step-parents, grandparents, or others)
Your answer
(2) Persons other than a parent/guardian permitted to pick up my child (I.D. required):
(include step-parents, grandparents, or others)
Your answer
(3) Persons other than a parent/guardian permitted to pick up my child (I.D. required):
(include step-parents, grandparents, or others)
Your answer
I understand that God's Backyard Bible Club for the Spring of 2018 runs each Wednesday from February 21 through May 2 (except March 28 & April 4). *
I understand that the children will perform in an evening "Kid's of the Kingdom" program for parents and families on May 2 at 6:30 PM in the First Presbyterian Church Fellowship Hall. *
We are requesting bus transportation from the following school for our child (we will notify you if we run out of room on the bus): *
Optional Family Meal at 5:30 PM each Wednesday of Bible Club: Please call the church office at 828-437-1811 by noon on the Monday before a God’s Backyard Bible Club to reserve a spot for dinner. (Cost: $7 adult, $5 child, $20 family cap) No cooking or washing dishes! *
Permission to Transport: I give permission for a driver from First Presbyterian Church to pick up my children from school between 2:45-3:30 PM each Wednesday that God’s Backyard Bible Club is in session and transport them to church. I understand that my children are expected to follow all applicable laws regarding riding in a motor vehicle and are expected to follow the directions provided by the driver and/or other adult volunteers. If my child needs a booster seat (non-bus riders), I understand that I must provide one. I understand that I am responsible for picking up my children at church at 5:30 PM. I also understand that it is my responsibility to notify the church office if my children will be absent. I grant permission for my children to be transported to First Presbyterian Church of Morganton, NC, from school despite the possible risks. I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, my children may risk personal injury or permanent loss. I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses. The undersigned gives permission for their children to be transported from school for the above named activity and releases First Presbyterian Church of Morganton, NC, their officers, employees, and agents from any liability whatsoever for any injury or death to person or loss or damage to property sustained by the undersigned for any member of his or her family in attendance, and the undersigned agrees to defend and indemnify First Presbyterian Church of Morganton, NC, their officers, employees, and agents from any liability or loss they might sustain by reason thereof. This document shall be valid for one year from the date signed. (Type your full legal name below as your electronic signature.) *
Your answer
The undersigned gives permission for their child to participate in God's Backyard Bible Club and releases First Presbyterian Church of Morganton, NC, their officers, employees, and agents from any liability whatsoever for any injury or death to person or loss or damage to property sustained by the undersigned for any member of his or her family in attendance, and the undersigned agrees to defend and indemnify First Presbyterian Church of Morganton, NC, their officers, employees, and agents from any liability or loss they might sustain by reason thereof. In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the Pastor or Program Director of First Presbyterian Church to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my child as named above. I also agree that any photographs taken of my child at or during this event are the property of First Presbyterian Church of Morganton, NC, and may be used in future publications and electronically as deemed appropriate. *
Type your full name for electronic signature. ex: Adam Christopher Bowling
Your answer
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