Providence Children's Ministry General Forms
Please fill out one form for each child that participates in Providence Baptist Children's Ministries. Included in this form is child and information, and a series of permission forms. This set of forms will need to be completed each school year. 
This form is valid from September 2023-August 2024. 
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Child's Name *
Child's Birthdate *
MM
/
DD
/
YYYY
Child's School *
Current Grade *

Important information about your child for us to know?

(i.e. allergies, helpful information about learning styles)


Does your child have any special talents or skills? (i.e.: play an instrument, art, sing, write, dance, video production, worship arts, public speaking etc. – please be specific)

What Providence Children’s Ministry programs your child is planning to participate in: 

Name of Parent/Guardian #1 *
Parent/Guardian #1 Phone Number *
Parent/Guardian Email #1 *
Name of Parent/Guardian #2 *
Parent/Guardian #2 Phone Number *
Parent/Guardian Email #2 *
Address

How can parents/guardians give back to Providence Baptist Children’s Ministry?

In order for our Children’s Ministry to be its best, it takes all of us. Sometimes this participation comes in the form of being present on a Sunday or Wednesday - volunteering to teach a Faith Formation Class or as Midweek leader or joining the Extended Session Rotation. Often we need participation around all ministry events we do with your child. If there is something you like to do or if you excel in a certain skill like organizing, cooking, carrying heavy loads, listening, teaching, or hosting, please list them below.


Is there anything that you want Elizabeth to know?


Medical Information
Any allergies? If so, what should we expect? How can we prevent and/or treat reactions if necessary? If none, please write "none." *

Current medical conditions or needs we need to be aware of?

Primary Doctor and Practice *
Physician's Number *
Insurance Information
Insurance Company *
Insurance Company's Phone Number *
Policy Holder's Name *
Policy Number *
Group Number *
Release Forms
Permission to Medically Treat
If a medical emergency should arise while at the outing/event and I cannot be immediately contacted, I hereby give permission to Providence Baptist Children's Ministry to select a physician and/or hospital for my child's care. I hereby also give the physician and/or hospital, as selected by Providence Baptist Children's Ministry, my permission to hospitalize, medically treat, order injections, anesthetize, or perform surgery as medically necessary for my child, as reasonably determined and advised by proper medical personnel.
 *
Permission to use Photo and Video
I grant Providence Baptist Church the right to take photographs and videos of my child and my family while engaged in actives with the church. I authorize Providence Baptist Church, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Providence Baptist Church may use such photographs and videos of my family with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.
 *
Permission to Participate
I, the undersigned, being the parent or legal guardian of the minor named above, give permission for our minor to attend and participate in ministry programs and activities sponsored by Providence Baptist Church from September 2023 through August 2024. I further acknowledge that any activity restrictions or event, I do not wish for my minor to participate in; I have indicated by my initials in the Activity Participation Section below.
Activity Participation: please list any activities your child may not participate in. (Examples: playing on playground, watching age appropriate movie, playing in the gym, etc.) If none, please write "none."
 *
Name of person who prepared this form: 
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