FLC Children's Ministry Sunday Programs Visitor Form
Please fill out the following information prior to your child's first time attending. This provides us with the details we need to properly care for your child and to reach you as their parent/guardian if needed.
Name of Child
*
First Name
Last Name
Name your child responds to?
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Female
Male
Medical Conditions/Allergies
*
Is your child bringing any medication with him/her?
*
Yes
No
If yes, please list:
Which Children's Sunday Program will your child be visiting?
*
9:15am Sunday School (Preschool-Kindergarten)
9:15am Sunday School (Grade 1-2)
9:15am Sunday School (Grade 3-4)
9:15am Sunday School (Grade 5-6)
11am Nursery (born 2023 or later)
11am Sunday Worship (Preschool-Kindergarten)
11am Kidz Church (Grade 1-2)
11am Kidz Church (Grade 3-4)
11am Kidz Church (Grade 5-6)
When will you be visiting?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Parent(s)/Guardian(s):
*
Relationship to Child
*
Father
Mother
Guardian
Cell Phone for Emergency Contact
*
Please enter a valid phone number.
Format: (000) 000-0000.
Release & Permission Statements
**MEDIA RELEASE** I/we, named above, authorize Fraser Lands Church to use any photographs or video taken of my child while participating in the children's programs of Fraser Lands Church. I/we understand that photographs or video of my child may be used in newsletters, printed promotional materials, bulletin boards, annual reports, on the Fraser Lands Church website, and on official Fraser Lands Church social media and consent to such use. Note: photos or video where a person is not identifiable may be used without consent. It is my responsibility as parent or guardian to instruct my child to avoid official ministry cameras if it is my preference that photos and videos of my child be used.
*
Yes
No
**CONSENT TO MEDICAL TREATMENT** I/we, the parents or guardians named above, authorize one of the Fraser Lands Church Ministry Staff or Volunteers to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.
*
I Agree
**LIABILITY RELEASE** I/we, named above undertake and agree to indemnify and hold blameless the Ministry Staff and Volunteers of Fraser Lands Church, its' Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Fraser Lands Church, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in events of Fraser Lands Church.
*
I Agree
I understand and acknowledge that when my child participates in the children's programs listed above, they are under supervision only during the applicable time periods stated above. I HAVE READ, UNDERSTOOD AND AGREE WITH ALL THE ABOVE AND SIGN IT TO COVER ALL FRASER LANDS CHURCH CHILDREN'S MINISTRY ACTIVITIES FOR THE CURRENT PROGRAM YEAR.
*
I Agree
Today's Date (NOTE: this form is ONLY valid for the Sunday your child will be visiting our Sunday programs during the selected hours)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
Should be Empty: