Child/Youth Registration

1 Parent

2 Children

3 Emergency Contact

4 Authorization

Parent / Guardian Information
Parent/Guardian*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Home Phone
Email*
Church You Attend (if applicable)
Legal Release
I (we), by signing this release, do hereby agree to the following: In the event of an accident or injury occurring on the premises of Faith Baptist Church, to myself (ourselves) and/or anyone else under my (our) care, control, or custody, do hereby agree to hold Faith Baptist Church and its insurance company free and harmless and to present no claim for damages against Faith Baptist Church or its insurance company.
Name of the Adult Authorized to Approve Medical Treatment for the child(ren)*
First Last

Extra Adult Emergency Contact
In case of emergency, accident or illness, reasonable efforts will be made to contact the parent/guardian. Please provide the emergency contact of a relative or friend to contact if you cannot be reached. Please advise them that you have put their name on this form. Please advise us of any changes throughout the year.
Name*
First Last
Relationship to the child(ren)*
Cell Phone*
Home Phone
Authorized Sign-Outs
Please list the names, relationships & phone numbers of the ADULTS (age 18 or older) authorized to sign your children (age 6 and under) out of FBC ministries. Any changes in sign out authorization need to be made at the time, or before, your child is dropped off.
Name
Relationship to the child(ren)
Phone Number
Name
Relationship to the child(ren)
Phone Number
Name
Relationship to the child(ren)
Phone Number
Name
Relationship to the child(ren)
Phone Number

Parent / Guardian Information