First Kids Camp Registration

First Kids Camp (March 1st & 2nd)

Step 1 of 4

General Infromation
Parent/Guardian Name*
First Last
Parent/Guardian Name
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone*
(###)###-####
Secondary Phone
(###)###-####
Email
Enter Email Confirm Email
Emergency Contact*
Please select someone that can be easily reached during their time with us.
Emergency Contact Numer*
(###)###-####

Aside from Parent(s)/Guardian(s),who is allowed to pick them up?

Child Information
Number of Children
Please enter a number from 1 to 10.
Child 1
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Grade Completed*
3 years thru 5th Grade
Age*
Special Needs/Allergies/Other Concerns
Child 2
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Grade Completed*
3 years thru 5th Grade
Age*
Special Needs/Allergies/Other Concerns
Child 3
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Grade Completed*
Age*
Special Needs/Allergies/Other Concerns
Child 4
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Grade Completed*
3 years thru 5th Grade
Age*
Special Needs/Allergies/Other Concerns
Child 5
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Grade Completed*
3 years thru 5th Grade
Age*
Special Needs/Allergies/Other Concerns
Child 6
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Grade Completed*
3 years thru 5th Grade
Age*
Special Needs/Allergies/Other Concerns
Days Attending
My children will be attending on...
Select ALL dates your children will be attending.
- Saturday (9/7)
- Sunday (9/8)

Releases
Release – Indemnification – Hold Harmless

The undersigned, as parent or legal guardian of the above-listed child, do hereby release, forever discharge and agree to hold harmless First Baptist Church of Cabool as its staff, employees, and volunteers from any and all liability, claims or demands for personal injury, illness or death, as well as property damage and expenses of any nature whatsoever which may be incurred by my/our child in the course of participation in or arising out of participation in the First Baptist Church of Cabool: First Kids. I further agree to hold the released parties harmless and indemnify them against any claims brought against them by third parties due to my child’s participation in First Kids.

Emergency Medical Care

I, as parent or legal guardian of the above-listed child, hereby give permission for my child to receive medical treatment and authorize a representative of First Baptist Church of Cabool to seek and/or authorize such medical treatment as is deemed necessary. I do hereby release, forever discharge and agree to hold harmless First Baptist Church of Cabool and its staff, employees, and volunteers from any and all liability, claims or demands for personal injury, illness or death, as well as property damage and expenses of any nature whatsoever which may be incurred by my child arising from the seeking of such medical treatment, the provision of such medical treatment and/or the failure to seek such medical treatment. I understand that I will be solely responsible for any medical, hospital or related charges, which may be incurred, on behalf of my child in connection with any injury, illness or other medical condition suffered by him/her.

Media Release

I, on behalf of the above-listed minor child, and myself hereby authorize taking photographs and videos of my child while participating in First Kids. I further give permission for First Baptist Church of Cabool to publish in print, electronic or video format any such likeness or image of my child taken. I release any and all claims with respect to copyright ownership and publication rights, including any claim for compensation.

The undersigned hereby acknowledge and agree to the Release – Indemnification – Hold Harmless, Emergency Medical Care and Media Release provisions listed above on behalf of my minor child and myself.
Release Form*
- I Approve of These Releases
- I Do Not Approve of These Releases
Signature*
Captcha

First Kids Camp (March 1st & 2nd)

Step 1 of 4

General Infromation

Child Information

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Days Attending

Releases

Trackbacks & Pingbacks

Comments are closed.

Can we help you find something?

Contact Us:

What’s New?

Follow Us

Subscribe to the Blog

Follow us on Twitter