Children-Permission-Form

FIRST BAPTIST CHURCH AMARILLO CHILDREN'S MINISTRY AUTHORIZATION FORM

AUG 2024 - AUG 2025

First*

Middle

Last*

Date of Birth*

Date

Grade*

Gender*

Street*

City*

State*

Zip*

Main Phone*

Other Phone

Parent Names*

In case of emergency, we will always try to contact parents first. Please provide an alternate emergency contact in the event that we cannot reach you.

Name*

Relationship*

Home Phone*

Work Phone*

Doctors Name*

Doctor's Phone Number*

Please list all medical, environmental allergies medications being taken medical problems or other pertinent information for this child. If none, please type NONE*

My permission is granted for the sponsors in charge to obtain necessary medical attention in the event that the above becomes sick or injured. I hereby release and forever discharge all sponsors of First Baptist Church Amarillo from all claims, demands, actions, or causes of action, past, present or future arising out of any damage or injury while participating with FBC Amarillo.

I give permission to publish pictures of my child in the Reporter or with the local media. I give permission for my child to participate in field trips after being notified of the specific

Signed*

Date*

Date

User understands typing their name constitutes as an electronic signature.

Parent Email*

example@example.com

Additional Email

example@example.com