Wednesday Night Life Registration

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Parent/Guardian Name* This field is required.This is your name

First Name

Last Name

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Parent/Guardian Phone Number* This field is required.

Please enter a valid phone number.

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Parent/Guardian Email* This field is required.

example@example.com

Confirm Email

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Mailing Address* This field is required.

Street Address

Street Address Line 2

City

State

Zip Code

Country

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Relationship to your child(s)

Mother

Father

Grand Parent

Legal Guardian

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Insurance InformationUsed ONLY in case of emergency. Continue if you choose not to provide this information at this time.

Insurance Provider

Primary Policy Holder

Insurance Policy Number

Insurance Company Phone Number

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I authorize medical and/or surgical treatment in the event of an emergency for my child by a physician and medical facility chosen by participating Event Sponsors. This is the original form or a facsimile of the original, signed form.* This field is required.

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Child 1 InformationEnter all information for your first child

Full Name

Grade

Gender

Allergies

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[1] Do you have more children to add?* This field is required.

YESNO

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Child 2 Information* This field is required.Enter all information for your second child

Full Name

Grade

Gender

Allergies

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[2] Do you have more children to add?* This field is required.

YESNO

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Child 3 Information* This field is required.Enter all information for your third child

Full Name

Grade

Gender

Allergies

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[3] Do you have more children to add?* This field is required.

YESNO

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Child 4 Information* This field is required.Enter all information for your forth child

Full Name

Grade

Gender

Allergies

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[4] Do you have more children to add?* This field is required.

YESNO

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Child 5 Information* This field is required.Enter all information for your fifth child

Full Name

Grade

Gender

Allergies

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[5] Do you have more children to add?* This field is required.

YESNO

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Child 6 Information* This field is required.If you have more children, please call the office at (936-291-3441)

Full Name

Grade

Gender

Allergies

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Student Terms and Conditions* This field is required.

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If your child attends either Alpha Omega Academy or Richards ISD; do they need transportation from their school to the church on the FBC bus?* This field is required.

YESNO

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NOTICE (Scroll to read all)

Please direct all temporary or permament changes to your child(s) transportation arrangments VIA TEXT MESSAGE to their respective program directors (listed below). Example: "Your child normally rides the bus home, but you will pick them up from the church directly instead."

Please send them a message with the content as follows:

{parentguardianName}
{child1[1]} - {child1[2]} (Include all children affected by the change.)
{child1[1]} will be picked up from the church tonight by me instead of riding the bus.

Debra Wion - Kingdom Kidz (K-5th)

(936) 662-5116

Chad Laurain - Awaken Youth (6th-12th)
(936) 206-0893

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Pick up by the bus for WNL activities at the following locations:* This field is required.

[BUS PICKUP] - Alpha Omega Academy (3891 SH 30, Huntsville, TX 77340)

[BUS PICKUP] - Richards School (9477 Panther St, Richards, TX 77873)

Other

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Pick-up by the parent at the end of the evening at the following locations:* This field is required.

[PARENT PICKUP AT CHURCH] First Baptist Church (1229 Avenue J, Huntsville, Texas 77340) - At 7:30pm

[BUS DROP-OFF] - Westway Baptist Church (12 Farm to Market Rd 3179, Huntsville, TX 77340) - At 7:45

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Transportation Rules & Safety Guidelines

In order to be sure that all children have a fun, safe and worthwhile day, we have a few rules to follow for riding the bus.

They are as follows:

Respect the driver.
Stay seated for the entire bus ride facing front with feet on the floor.
Be courteous – name calling, pranks, teasing, bullying, inappropriate or foul language is not acceptable.
Keep head, hands, and feet to yourself and inside the bus at all times.
Talk quietly – yelling or screaming is unacceptable.
Do not throw any objects on the bus, at the bus, or out of the bus.
Destruction of bus or personal property will not be tolerated.
Cooperate with the bus driver and helpers – follow their directions.
Follow the safe boarding and departing bus procedures directed by the driver.
Please do not bring any of the following:
1. Knives or weapons of any kind
2. Lighters, matches, explosives, or fireworks
3. Laser pens/pointers
4. Drugs, alcoholic beverages, or tobacco products in any form
All electronic devices (cell phones, IPods, IPhones, laptops, gaming devices, etc) need to remain in a pocket or backpack at all times while on the bus, unless permission given by an adult on the bus.

**Riding the church bus is a privilege, not a right. Any violation of the above rules may result in bus privileges being revoked.**

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By signing, your child agrees to follow all rules listed on the previous page. Failure to follow these rules can result in your child not being allowed to ride in First Baptist Church's vehicles in the future.

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By signing, you hereby authorize First Baptist Church to transport your child/children to and from our facilities.* This field is required.

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By signing, you hereby confirm that all data entered into this form is correct.* This field is required.

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