The First Baptist Church of North Adams
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Sunday School Registration - Youth K-5th
Child's Name
*
First
Last
Child Address
*
Line 1
Line 2
City
State
Zip Code
Country
Date of Birth
*
Age
*
Grade AND School
*
Parent #1 Name
*
Parent #1 Address
*
Line 1
Line 2
City
State
Zip Code
Country
Parent #1 Email
*
Parent #1 Home Phone
*
Parent #1 Cell Phone
*
Parent #1 Work Phone
*
Parent #2 Name
*
Parent #2 Email
*
Parent #2 Address
*
Line 1
Line 2
City
State
Zip Code
Country
Parent #2 Home Phone
*
Parent #2 Cell Phone
*
Parent #2 Work Phone
*
Emergency Contact Name
*
Emergency Contact Phone
*
Allergies or Medications? Please list.
*
Please list any allergies your child may have as well as any other information we need about recognizing and/or treating.
Trips - Please check all that apply:
*
I/We hereby give permission for my/our child(ren) to attend and participate in activities sponsored by the Youth & Children’s Ministries of First Baptist Church North Adams (FBCNA).
I/We understand that some of these activities will take place at the church, while other activities may require traveling to other locations.
I/We authorize my/our child(ren) to be transported by the caregivers at FBCNA in designated vehicles for all trips. When necessary, I/we also authorize my/or child(ren) to be transported across state lines and national boundaries when participating in activities.
I/We also give my/our child(ren) permission to participate in activities that involve overnight stays.
Please note that the first option is necessary to attend any event at FBCNA.
Photos - Please check all that apply:
*
I/We give permission to FBCNA to photograph my/our child(ren) and use these photographs in all forms of media, and for any and all promotional purposes including advertising, display, audiovisual, exhibition, or editorial use.
I/We consent to the use of the name of the child(ren) in connection with the photographs, if needed, and I/we understand that I/we will not be financially compensated for their use.
Medical Treatment - Please check all that apply:
*
I/We authorize any adult advisor or chaperone to administer over-the-counter medication and/or first aid, should the need arise.
I/We authorize an adult, in whose case the minor(s) has been entrusted, to consent to X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of a physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
I/We shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child(ren) pursuant to this authorization.
Should it be necessary for my/our child(ren) to return home due to medical reasons or otherwise, I/we shall assume all transportation costs.
By checking this box and typing your name in below, you are stating that you are authorized to make decisions for the child listed above. Your digital signature on this form will be treated as a written one. Thank You.
*
I am an authorized parent/guardian for the child listed above.
Type in your Full Name. Thank You.
*
Date:
*
Please comment on any selections you are not able to select:
*
Please list insurance info below or provide a copy to the church office.
*
Submit
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