First Baptist Church of Trimmier
Sunday, November 19, 2017
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
First Baptist Church Trimmier
When:   June 19-23, 2017
Time:     5:30pm – 8:30pm
Where: 6405 Chaparral Rd.
       Killeen, TX

 
 Print Registration and bring!!
 
Child’s Name:________________________ Gender:_____   
Child’s Age:_______ Date of Birth:_____________
Last School Grade Completed:_______________________   
Name of Parent(s) or Legal Guardian:_______________________________________           
Name of Person Authorized to pick up child:____________         
Name of Person Authorized to pick up child:____________         
Street Address: _____________________________________________              
 
City:_____________ State:______  Zip:___________   
Home Telephone: (_____)  _____-____________    
Parent / Caregiver’s Cell Phone: (_____)  _____-_________
Email Address: _________________________________              
Home Church (if any):______________________________        
 
Medical Information
Allergies or Other Medical Conditions:_____________________________________           
In Case of Emergency, contact: _______________________________________           
Phone:  (_____) _____-________
Relationship to Child: _____________________________       


FIRST BAPTIST CHURCH VBS LIABILITY RELEASE AND PHOTOGRAPHY / VIDEO AUTHORIZATION
 In the event of an emergency, I understand that all will be done to contact me or the emergency contact named above. However, if neither can be reached, I give full permission to a representative of First Baptist Church Trimmier to seek medical attention in my absence for the child registered on this form.
 I also hereby assume all risk, known or unknown, for the child registered on this form, in connection with their attendance and participation in Vacation Bible School at First Baptist Church Trimmier.
 I acknowledge that participation in Vacation Bible School at First Baptist Church Trimmier is voluntary and therefore I FULLY RELEASE and discharge First Baptist Church Trimmier, its pastors, employees, directors, and volunteer workers, from any and all liability in connection with any activities carried on at First Baptist Church Trimmier in the Vacation Bible School program.
 I further acknowledge that the child registered on this form, as a participant in Vacation Bible School at First Baptist Church Trimmier, may be photographed or captured on video during the Vacation Bible School program and activities. I hereby grant full permission to First Baptist Church Trimmier to use photographs or videos-in print, electronic, online, or other public media - of the child registered on this form and further release First Baptist Church Trimmier from any and all liability connected with the authorized use of words and image of the child registered on this form.
                                                                       
Printed Name of Child:_____________________________       Printed Name of Parent or Legal Guardian:_______________________________________
                                                                            
Signature of Child’s Parent or Legal Guardian:
______________________________________________
                
Date of Signature:_____________________