Children's Permission Form

FIRST BAPTIST CHURCH AMARILLO
CHILDREN’S MINISTRY AUTHORIZATION FORM
August 2024 – August 2025

Please fill out for one child at a time, please do not put multiple children on one submission. We must have an individual form on file for each child.

Thank you.

Child's Name (First, Middle, Last) *

Date of Birth (MM/DD/YYYY) * +

Grade (2024-2025 School Year) *

Gender *

Male

Female

Address (Street, City, State, Zip) *

Main Phone Number *

Other Phone Number

Parent Name(s) *

EMERGENCY CONTACT INFORMATION:

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

Name *

Relationship *

Main Phone Number *

Other Phone Number

Doctor's Name *

Doctor's Phone Number *

Please list all medical/environmental allergies, medications being taken, medical problems or other pertinent information for this child. Please type NONE if 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 event.

I understand that entering my name below constitutes as my electronic signature. *

YES

Name *

Parent Email Address *

Additional Email Address