First Baptist Church VBS 2019
Child Information Form
Email address *
Child - First & Last Name
Child - Grade Just Completed
Child's Address - Street Address
Child's Address - City & State
Child's Address - Zip Code
Parent/Guardian (First & Last Name)
Parent/Guardian (Contact Number)
Emergency Contact Person (First & Last Name)
Emergency Contact (Phone Number)
Does your child have food allergies? (Use N/A if none.)
Transportation to and from Vacation Bible School
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I/We, the undersigned parent(s) or legal guardians(s) of the above-named minor, know that I may not be available to authorize medical care of said minor child and I wish to appoint someone to act in my place in the absence and to give such authorization. This authorization is intended to give First Baptist Church staff and leaders (herein referred to as FBC) the right to give consent to authorize emergency medical care in the event of accident, injury, or sickness. I also assume the financial responsibility for any medical treatment of the above-named minor. It is intended that this document be presented to the physician or appropriate hospital or medical representative at such times as the medical care shall be authorized. It is intended that the authorization relieve the physician, dentist, person rendering such care at the hospital or institution in which such care is given, from any liability resulting from the failure of me, the parent or guardian of the above-named minor, from signing a consent or authorization to render such care. It is the intent of that FBC shall act in my stead in making such decisions. I have put the important medical facts, if any, on this form. The medical facts are intended to help the doctor in deciding what treatment is to be given, but are in no way intended to restrict the giving of authorization or consent by FBC. I understand that this form is in effect from the date signed and that it is my responsibility to inform FBC of any changes to this form. It is my understanding that this form also serves to establish my consent and permission for the above-named minor to participate in FBC programs, instruction, and study, which may be photographed for us by the FBC in advertising and public relations materials.
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