FBCN Liability Release and Information Form 2024

FBCN Liability and Release Information Form

Adventure Club 2024/2025
FIRST BAPTIST CHURCH OF NARRAGANSETT

305 Kingstown Road
Narragansett, RI 02882

Kids Adventure Club
Held on select Tuesdays

4-5:30 PM
Outdoor games(dress appropriately)
Snacks
Share a lesson from God's Word
FREE

DATES
11/12, 11/26,12/10, 1/14, 1/28, 2/11,
2/25, 3/11, 3/25, 4/8, 4/22, 5/6, 5/20, 6/3, 6/17
Name of Child #1*

First NameLast Name
Grade
Age
Allergies
Name of Child #2

First NameLast Name
Grade
Age
Allergies
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Parent/Guardian*

First NameLast Name
Primary contact phone number *
Email*
example@example.com
Secondary contact name *
Secondary phone number*
Person to call first in an emergency*
For safety and security we will use a password system for releasing children from Adventure Club. For a person to take a child they will have to provide the password established by the adult guardian for that child.
Password for releasing child*
Do you give permission for your child(ren) to appear on social media, First Baptist Church of Narragansett or other affiliated websites and/or the newspaper *without* their names being mentioned?

yesno
Any additional information or comments
Liability Release Form

Event: Adventure Club, held on select Tuesdays in 2024/2025 at First Baptist Church of Narragansett, 305 Kingstown Road, Narragansett, RI from 4pm-5:30pm.

By signing below, I assume any risk of harm or injury which might occur to the participant due to his/her participation in the event or activity, I release the organization or business named above from all liability, costs and damages which might arise from participation in the above named event or activity.

If the participant is a minor, I agree that the minor has my consent to participate in the event. I further provide my consent for the organization or business named above to seek emergency treatment for the minor if necessary. I agree to accept financial responsibility for the costs related to this emergency treatment.
Name of parent/guardian *
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

FBCN Liability and Release Information Form

FIRST BAPTIST CHURCH OF NARRAGANSETT

Liability Release Form