KIDLife Permission to Participate and Medical Release
Please enroll my child in KIDLife at First Baptist Church of Lowell, Arkansas. I give my permission for my child to participate fully in weekly activities. I understand that the purpose of KIDLife is to disciple our children in the development of their personal relationship with our Lord and Savior, Jesus Christ, through the memorization of Bible verses and weekly discipleship
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Child's Name:  *
Age:  *
Grade: *
Date of Birth: *
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Parent or Guardian Name:  *
Address:  *
City:  *
Zip Code:  *
Cell Phone:  *
Email:  *
Other Parent or Guardian Name:  *
Other Parent or Guardian Cell Phone:  *
Other Parent or Guardian Email: 
Besides parents, who else has permission to pick up your child on Wednesday evenings? 
Is there anyone who is not allowed to pick up your child?
On Wednesday evening, a parent may generally be reached at:  *
In the event that medical treatment is required, I grant permission for First Baptist Church of Lowell to secure the services of a physician, and I grant that physician permission to provide the necessary care for the well being of my child. I understand that every attempt will be made to contact me prior to any treatment. I, the undersigned, do release, acquit, discharge, and hold harmless First Baptist Church and its representatives or any attending physicians from any and all damages or liabilities arising out of treatment of any sickness or accident incurred by my child.  *
Parent Signature:  *
Please list any physical restrictions your child has that would limit participation in any activity: 
Please list any allergies, pertinent medical information, and special needs information: 
Medical Insurance Company
Insurance Policy Number: 
Please list any other information here: 
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