Please submit one form per child.

Please include full city and zipcode if not Washington 30673.

Please include the name and number of at least one adult other than the primary parent information listed previously.

Please list the names and phone numbers of any additional people you would like to allow to pickup your child. Children will only be released to the Parents, Emergency Contact, and those named here.

If your child is allergic to anything (such as peanuts, etc), has dietary restrictions (gluten free, etc), takes special medication, or has a medical condition (such as Asthma, etc), please list it below.

Have a question or concern? Write it here and our staff will respond to the email primary email submitted.

In signing this form, I acknowledge that I am the legal parent, guardian, or caregiver of the above listed Child (a minor) and have read, understood, and agree to everything outlined in the Medical & Media Release on behalf of the Child. I agree to the Child's participation in activities, events, ministries, retreats, and trips with, at, or by First Baptist Church and their staff, agents, assistants, and volunteers. I acknowledge and consent that, in brief, FBC may transport, photograph, record, and provide reasonable care for my child during the duration of the above mentioned activity. Furthermore, I acknowledge that in my absence, the alternate contact listed above, if any, may function as my proxy for all purposes.