PALS New Student 2025-2026 Registration Form

Medical Consent and Emergency Form 2025-2026
In the event child's name* becomes ill or sustains an injury while participating in the PALS program of First Baptist Church Hartselle, AL, I, the undersigned parent/guardian, give my permission to those in charge to take whatever steps are necessary to stop bleeding and to administer first aid, including emergency transportation if I cannot be reached immediately.

I also consent to an x-ray examination, anesthesia, medical or dental or surgical diagnosis and treatment and hospital care, and the administration of drugs or medicine to be rendered to my child under the general or specialized supervision, and upon the advice of a duly licensed physician and/or surgeon. I agree to be responsible for any medical expenses incurred.

If parent/guardian refuses to sign, instructions must be attached stating what procedure the program is to follow in an emergency.
Any special health concerns, or health/medical instructions? Is your child enrolled in therapy?
What medications does your child take?
Please list all allergies & reactions (also include if your child has an EpiPen):
Regular doctor:*
Doctor Phone Number
Please enter a valid phone number.
Insurance carrier & policy:
Person authorized to act for parent in case of an emergency (aside from previously named guardians):*
Name & Relation
Emergency Contact Phone Number*
Please enter a valid phone number.

Release Form
Library Walk Release

*This applies to 3 & 4 year old classes only.
The undersigned parent/guardian hereby gives permission to PALS for my child child's name to walk with his/her group to the library once per month.
Media Release
The undersigned parent/legal guardian hereby gives permission to PALS for child's name
to be photographed and/or videoed for internal use.to appear on FBCH/PALS social media platforms.to appear on the FBCH/PALS website.
Signature

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Pick-up Authorization Form
Please list all persons authorized to pick-up your child from PALS. Any person picking up your child must be on this list. Siblings under the age of 16 may not pick-up your child from PALS.*
Should be Empty:

New Student Registration Form