FBC Kids Registration -- 1st - 4th
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Child's Name *
Birth Date *
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Gender *
Address *
Parents/Legal Guardian *
Email *
Phone Number *
Phone Number
Work Number
Work Number
Best time to contact:
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Alternate Contact *
Phone Number *
Grade in School this September: *
Name of Church you attend for Worship
Special Medical Needs
Other Needs or Concerns
Authorization
In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by First Baptist Church Maryville, MO to secure and administer treatment, including hospitalization, ambulance transport, and paramedics for the person named above. I hereby agree to fully pay all costs of medical or dental care incurred by First Baptist Church Maryville, MO or their agent for the child under authorization.
Pictures and video may be taken during the event for church use.
This form, when completed, may be photocopied for our records.
Parent/Legal Guardian Signature *
Today's Date: *
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Submit
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