REGISTER FOR CHILDREN'S MINISTRY CLICK HERE

VBS/Cubbies/K4C Registration

For children 4 years old to just completed 6th grade.
Child Information
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
YesNo
Where?
Please provide any medical or other information we should know about the child (including food allergies).*
Second Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
YesNo
Where?
Please provide any medical or other information we should know about the child (including food allergies).*
Third Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
YesNo
Where?
Please provide any medical or other information we should know about the child (including food allergies).*
Fourth Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
YesNo
Where?
Please provide any medical or other information we should know about the child (including food allergies).*
Child Release Information
Parent/Legal Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names of Persons to which the child (children) may be released to (Please provide at least two) We cannot release your child to someone not listed*

First NameLast Name
Full Name*

First NameLast Name
Full Name

First NameLast Name
Full Name

First NameLast Name
YesNo
Who may you child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)*

First NameLast Name

Emergency Contact 2 Phone Number*

Area CodePhone Number
Medical Treatment Consent

Please read and agree
CONSENT FOR MEDICAL TREATMENT |

As the parent or legal guardian of the above-named participant, I hereby give my consent for their participation in the First Baptist Church of Niles' Children's program.

In the event that my child becomes ill or injured while under church supervision, I approve the church representative to take the following steps:

1) Contact a parent, guardian, or emergency contact of the young person and follow his/her instructions.
2) In the event that the above parent, guardian or emergency contact cannot be reached, contact the young person's physician and follow his/her instructions.
3) If the young person's physician cannot be reached, the church representative will use their own judgment in contacting a properly liscensed practicing physician and follow his/her instructions.
4) In the case the young person is involved in an accident and/or requires treatment, the attending physician has my permission to examine and begin treatment in my absence. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.

I agree to relieve First Baptist Church of Niles and its representatives from any liability in connection with the above activities and instructions.
Agree
Discipline Policy

Please read and agree
In order to run a safe and productive children’s ministry here at First Baptist Church of Niles, we strive to encourage the children to behave in an appropriate manner. This means that certain guidelines must be in place.

Incidents of misbehavior or disrespect will be handled in the following manner:

1: Warning Given.

2: Moved to a different area from his/her current place/activity.

3: Removed: This will include being sent to the office while a parent or guardian is notified. In the case that the parent/guardian is unable to be reached, the child will stay in the office until the end of the event, at which point they will be returned home with a notification that the parents/guardians will have to contact the church before they are able to return.

NOTE: Certain behavior will result in automatic removal (Step 3) including, but not limited to fighting and foul language.

1st Time Sent Home: 1 week of no club.

2nd Time: 2 weeks

3rd Time: not allowed to return for the duration of this year's ministry.

Electronic Device Policy: If Electronic Devices are seen or heard they will be turned into a leader and then will be returned to the student at the end of the evening.

Our goal is for the above discipline to be administered in a loving, firm, and patient manner so that all those involved in any church activity will be able to enjoy all the benefits of participation.

I understand the above disciplinary policy and agree to cooperate with First Baptist Church of Niles in any disciplinary incidents involving my child.
Agree
Should be Empty:

VBS/Cubbies/K4C Registration

Child Information

Second Child

Third Child

Fourth Child

Child Release Information

Medical Treatment Consent

Discipline Policy