HBC presents Firm Foundation Kids Club--Registration Form

Heritage Baptist Church Presents Firm Foundation Kids Club
Child's Name*
Date of Birth (mm/dd/yyyy)*

MonthDayYear
Date
Grade*
Please enter a value between Kindergarten and Gr 4.
School
Home Church
Address (Street/Box, City, Postal Code)*
Parent/Guardian Name(s)*
Home Phone*
Work Phone
Cell Phone
Email*
example@example.com
Emergency Contact Full Name*
Relationship to child*
Phone Number(s)*
Health Information (Please list any allergies or important medical information or type None)*
I understand all reasonable safety precautions will be taken at all times by Heritage Baptist Church Firm Foundation Kids' Club and its agents during the club nights. I hereby give permission to the child listed on the first page of this form to attend Firm Foundation Kids' Club at Heritage Baptist Church, Yorkton, SK on Thursday nights. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Heritage Baptist Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Consent for Photography Release

I give consent for the photographs taken at Firm Foundation Kids' Club meetings to be used for the promotion of the Heritage Baptist Church Firm Foundation Kids' Club. I understand that this will involve pictures of the above mentioned student being publicized within the church. on website and places deemed acceptable by those involved leading the Heritage Baptist Church Firm Foundation Kids' Club.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Heritage Baptist Church Presents Firm Foundation Kids Club