2016 Registration Paperwork

1201 N Robinson
Oklahoma City, OK 73103
Dear Parents,
It’s time for Kids Off Broadway, a super week of fun and music for children to be held June 13-17,
2016. Kids who are entering 1st - 7th grade are invited to participate. Actors, dancers, speakers, and
choir members work hard each morning to learn a musical. Experienced leaders guide children as
they practice each part. We take a break in the afternoons and go on field trips where we relax and
have fun with friends.
We also have a class called KOB, Jr. just for 4 and 5 year olds who have not completed kindergarten.
This class does not learn a musical, but they will learn some songs to share with us on Friday night.
KOB, Jr. holds all the fun of older classes – singing, crafts, Bible study, and recreation, but field trips
for this class will be held at FBCOKC – no traveling! This class has limited enrollment, so if you are
interested, please contact Kristin immediately.
We will hold auditions for solos and speaking parts on Sunday, May 15th from 2:30pm to
3:30pm. You can enter at the north doors, by the playground, and follow the signs to the second floor
to find the audition room. Auditions are not required to participate in KOB. Children who want to
audition for a solo or speaking part do not need to prepare anything ahead of time. They will be asked
to sing a simple, familiar song or to read a few lines. Soloists will be notified by the week of June 1st of
their parts. We will distribute music and scripts at that time.
Enclosed is a registration and information packet. Fees are fully refundable in the event your child
cannot attend Kids Off Broadway. Your fees cover all costs of the week, including a t-shirt, afternoon
recreation, transportation, and food. Registration and fees are due no later than Friday,
June 3rd.
Transportation for our afternoon recreation is provided by OKC Public Schools. We will travel in a bus
with a licensed bus driver. All of our adult sponsors are thoroughly screened. We have a nurse and
safety officer to help us stay safe and healthy. We are prepared for fun and safety!
If you have teenager interested in being a part of Music Police, please contact us immediately.
These spots fill up fast!
We look forward to another great year!
Kristin Rogers
Minister to Children and Families
[email protected]
232-4255 x124
Kim Greer
Minister of Music and Worship
[email protected]
Kids Off Broadway!
Schedule for 1st – 7th Grade
June 13-17, 2016
Schedule
Monday - Thursday
7:30am
Early Drop-Off for free time in the gym
9:00am
Rehearsals (both large group and small group)
Drama practice
Solo Rehearsal
Bible study and snack
Recreation
11:30pm
Lunch
12:30
Missions
12:45
Rehearsal
1:45pm
Field trip or afternoon activity
4:30pm
Return to church for snack
5:30pm
All children should be picked up by 5:30pm
Schedule
Friday
7:30am
9:00am
12:30pm
1:00pm
4:00pm
5:00pm
5:30pm
6:30pm
Early Drop-Off for free time in the gym
Rehearsal
Lunch!
Movie time – bring blankets and pillows
Dress rehearsal – please notice that children stay at FBC until after performance
Light dinner
Change into performance t-shirts
PERFORMANCE – invite family and friends!
Cost for Kids Off Broadway
Regular Registration
$85 per child
Late Registration
June 5 – June 12
$95 per child
Make checks payable to First Baptist Church of OKC
Kids Off Broadway Jr!
Schedule for 4 and 5 year olds
(If they have completed kindergarten, please enroll in KOB)
June 13-17, 2016
Schedule
Monday - Thursday
7:30am
Early Drop-Off for free time in the classroom
9:00am
Rehearsal
10:00am
Snack and Bible study
11:15pm
Lunch
11:45am
Lessons, crafts
12:15pm
Recreation
12:45pm
Rehearsal
1:30pm
Rest time – your child may want to bring a pillow and blanket to keep here all week
2:30pm
Afternoon “field trip” at church
4:00pm
Snack and free play
5:30pm
All children should be picked up by 5:30pm
Schedule
Friday
7:30am
9:00am
10:00am
11:15pm
11:45am
12:15pm
1:30pm
4:00pm
5:00pm
5:30pm
6:30pm
Early Drop-Off for free time in the classroom
Rehearsal
Snack and Bible study
Lunch
Lessons, crafts
Rehearse in the Sanctuary
Movie time – bring pillows and blankets
Dress rehearsal – please notice that children stay at FBC until after performance
Light dinner
Change into performance t-shirts
PERFORMANCE – invite family and friends!
Cost for Kids Off Broadway Jr.
Registration
$65 per child
Make checks payable to First Baptist Church of OKC
Field Trips for KOB 2016
Grade is the grade your child is entering in Fall 2016
Monday, June 13
KOB, Jr
1st – 2nd Grade
3rd – 5th Grade
6th – 7th Grade
Inflatables in the Gym
Zoo
Zoo
Zoo
Tuesday, June 14
KOB, Jr.
1st – 2nd Grade
3rd – 5th Grade
6th – 7th Grade
Water day on the playground
Sprayground
Riversport
Riversport
Wednesday, June 15
KOB, Jr
1st – 2nd Grade
3rd – 5th Grade
6th – 7th Grade
House of Clay
House of Clay
Swim at OU
Volunteer at the Food Bank
Thursday, June 16
KOB, Jr.
1st – 2nd Grade
3rd – 5th Grade
6th – 7th Grade
Extreme Animals visit us
Riversport
Volunteer at the Food Bank
Swim at OU
Friday, June 17
All ages
Movie day at church!
Field trips are subject to change.
Kids Off Broadway 2016
Completed Registration Checklist
__ Contact Information Form
__ Medical History and Information
__ Release of Claims, Hold Harmless and Authorization For Emergency Medical or Dental Care Form
Complete one form per family, but please list each child’s name at the top of the page
__ Field trip permission forms:
Riversport/Oklahoma Boathouse – all KOB participants, excluding KOB, Jr.
OU Swim – all kids entering grades 3-5 (one form per family is acceptable)
Food Bank – all kids entering grades 3-5
__ T-Shirt and CD Order Form
__ Fees enclosed, check made payable to First Baptist Church of OKC
• Registration Fee
$85 per child
$95 per child after June 6th
$65 for KOB, Jr. (please be sure you have a spot before paying for KOB, Jr.)
• Listening CD, upon request ($10)
Online credit card payment option is available:
Go to www.fbcokc.org
Choose “Donate Now” on the bottom left of the page and fill out the form
When paying online, please write “Kids Off Broadway” and your child’s name in the comment section.
Return all forms and fees to:
First Baptist Church of Oklahoma City
Kristin Rogers
1201 N Robinson
OKC, OK 73103
Fax: 405-272-2939
If you would like to be considered for a scholarship, please complete the fields below.
How many scholarships are you requesting? __________________________________________
Has your child attended Kids Off Broadway before? How many years? ______________________
Explain why you would like to be considered for a scholarship.
Contact Information
One Form per Family
________________________________________________________________________________
Name of Child or Children and Grade Entering in Fall 2016 – Don’t forget the grade!
________________________________________________________________________________
Parent’s/Guardian’s Name(s)
________________________________________________________________________________
Children’s Home Address with city, state and zip
____________________ ___________________________________________________________
Home Phone
Email
___________________________________
Emergency Phone
______________________________________
Phone Type (cell, work) and Contact (mom, dad)
___________________________________
Emergency Phone
______________________________________
Phone Type (cell, work) and Contact (mom, dad)
Website Permission Agreement
By signing below, I give permission for my child(ren) to be photographed and to be included on the
First Baptist Church of Oklahoma City website (www.fbcokc.org) or in printed advertising for Kids Off
Broadway or children’s ministries at the First Baptist Church of Oklahoma City.
(You are not required to sign this for your child to participate in Kids Off Broadway.)
______________________________________________________________________________
Parent or Guardian Signature
_________________________________________
Date
Medical History and Information
One Form Per Family
______________________________________
Child’s Name/Children
_____________________________________
Date(s) of Birth
______________________________________
Name of Child’s Physician
_____________________________________
Doctor’s Phone Number
______________________________________
Medical Insurance Company
_____________________________________
Policy #
______________________________________
Name of Policy Holder
_____________________________________
Group #
Medications currently being taken and how often. Please indicate if we need to administer this
medication and detailed dosage instructions.
________________________________________________________________________________
________________________________________________________________________________
List any medical conditions, allergies, or physical handicaps of which we need to be aware.
________________________________________________________________________________
________________________________________________________________________________
Should your child need emergency medical care at any time during this period, please list any special
instructions that you require of the medical personnel. Include medication allergies, rare blood type,
or other factors that would be necessary in caring for your child.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
I give permission to administer over the counter medications
Advil/Motrin (ibuprofen) Yes No
Tylenol (acetaminophen) Yes No
Benadryl
Yes No
Is your child allergic to any of the following?
Latex
Yes No
Insect Stings
Yes No
RELEASE OF CLAIMS, HOLD HARMLESS AND
AUTHORIZATION FOR EMERGENCY MEDICAL
OR DENTAL CARE TO MINOR
This Release and Consent is entered into on this ___ day of _________ year __________,
by ___________________________________ (Parent), the parent or legal guardian of
_____________________________________________________ (hereinafter referred to as
Minor(s)).
1. Parent warrants and agrees that he/she (a) has legal custody or is the legal guardian of the
Minor(s) listed above; (b) understands the terms of the Release and Consent, and (c) has
signed this document by his/her own free will.
2. Parent acknowledges that Minor(s) will, with Parents permission, participate in certain activities
conducted by or sponsored by The First Baptist Church of Oklahoma City (Ministry), its
Directors, Officers, employees, and agents during the duration of this agreement.
3. Parent, individually and on behalf of Minor(s), releases and agrees to hold Ministry harmless
from all liability for harm to Minor(s) or Minor(s) personal property, resulting directly or indirectly
from Minor(s) participation in Ministry activities. Parent, individually and on behalf of Minor(s),
personally assumes all risks and liabilities in connection with Minor(s) participation in Ministry
activities and agrees to indemnify Ministry against any liability which might be assessed
against it as a direct or indirect results of Minor(s) participation in Ministry activities.
4. In the event of Minor(s) injury during any Ministry activity and Parents unavailability to
authorize medical treatment, parent authorizes dental, medical, or surgical treatment, including
but not limited to the administration of X-rays, anesthetic, anesthesia, by any medical
professional chosen by the Ministry. Parent understands and agrees that this consent is given
to encourage the Ministry and the medical professional to exercise their best judgment as to
such diagnosis or medical, dental, or surgical treatment. Parent personally assumes the duty
of payment of any medical, professional, hospital, clinical, or ambulance service and releases
Ministry from any such duty of payment. This medical authorization is provided pursuant to
Title 10, Section 170.1 of the Oklahoma statutes.
5. Parent understands and agrees that this Release and Consent shall remain in effect for a
period of one (1) year or until Parents written revocation, whichever is first, and that Parents
consent to treatment shall remain in effect until revoked orally or in writing to The First Baptist
Church of Oklahoma City or to the licensed medical professional treating Minor(s).
_______________________________________
Parent or Guardian Signature
_________________________
Date
T-Shirt Order
List each child circle the size t-shirt needed.
Child’s Name ____________________________________________________
Child S
Child M
Child L
Adult S
Adult M
Adult L
Adult XL Adult XXL
Child’s Name ____________________________________________________
Child S
Child M
Child L
Adult S
Adult M
Adult L
Adult XL Adult XXL
Child’s Name ____________________________________________________
Child S
Child M
Child L
Adult S
Adult M
Adult L
Adult XL Adult XXL
CD Order Form
Do you wish to purchase a listening CD of the musical? Cost is $10 per CD. Soloists and major
characters will be provided with a CD of their part. This is a CD of the songs we are singing so that
kids can practice and enjoy the music. Please not that this is not a recording of the performance.
We are not legally allowed to record the performance and provide that to you.
Yes
No
2015 WAIVER
OKC RIVERSPORT • OKLAHOMA RIVER ADVENTURES
CHESAPEAKE BOATHOUSE • DEVON BOATHOUSE • CHESAPEAKE FINISH LINE TOWER
ROUTE 66 BOATHOUSE • EXCHANGE BOATHOUSE • BOATHOUSE DISTRICT GROUNDS
IN CONSIDERATION of being given the opportunity to participate in any OKC BOATHOUSE FOUNDATION (Foundation)
activities ("Activity") including scheduled, supervised programs, rental activities and registered regattas, and any activity
taking place in buildings or on grounds managed or owned by the Foundation during the policy term 12/31/14 – 12/31/15,
I, for myself, my personal representatives, assigns, heirs, and next of kin:
1. ACKNOWLEDGE, agree and represent that I understand the nature of Rowing, Kayaking, Dragon Boating, Pedal
Boating, Stand-Up Paddle Boards, Fitness, Zip Lining, Rock Climbing, Bicycling and Adventure Sports, both on water and
land based, and that I (or my minor child) _______________________________________________, is qualified, in good
health, and in proper physical condition to participate in such Activity.
2. AGREE AND WARRANT that I will examine and inspect each Activity in which I take part and that, if I observe any
condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the
Activity and will refuse to take part in the Activity until the condition has been corrected to my satisfaction.
3. FULLY UNDERSTAND that: (a.); ROWING, KAYAKING, DRAGON BOATING, PEDAL BOATING, STAND-UP
PADDLE BOARDS, ZIP LINING, ROCK CLIMBING, BICYCLING, FITNESS ACTIVITIES & ADVENTURE SPORTS
INVOLVE RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis and death ("Risks");
(b.) these Risks and dangers may be caused by my (or my minor child's) own actions, or inactions, the actions or
inactions of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the
Releases names below; (c.); there may be other risks and social and economic losses either not known to me or not
readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY
FOR LOSSES, COSTS, AND DAMAGES incurred as a result of my or my minor child's participation in the Activity.
4. HEREBY GRANT to the Foundation and their subcontractors (which includes employees, agents, successors,
licensees and assigns), the irrevocable right and license to use my likeness as photographed and/or videotaped during
participation in boathouse activities; and to use or authorize the use of such images or any portion thereof in any manner
or media at any time in perpetuity, and to use my name and likeness therewith, including promotion in all media.
5. I HEARBY RELEASE, discharge, covenant not to sue USRowing, USA Canoe & Kayak, the Oklahoma City Boathouse
Foundation, Schlegel Bicycles, Central Oklahoma Transportation & Parking Authority, Hornblower Marine Services, City
of Oklahoma City, their administrators, directors, agents, officers, volunteers and employees, other participating regatta
organizers, any sponsors, advertisers, and if applicable, owners and lessors of premises, on which the Activity takes
place, (each considered on of the Releasees herein) from all liability, claims, demands, losses or damages on my account
caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, including negligent
rescue operations; release and discharge them from any and all claims whatsoever in connection with the use of my (or
my minor child’s) image; and further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes
a claim against any of the above Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the Releasees
from any litigation expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim.
I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and
have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and
unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is
held to be invalid, the balance, notwithstanding, shall continue in full force and effect.
Participant Name ______________________________________________________________________________
Printed Name of Parent/Guardian__________________________________________________________________
Address______________________________________________________________________________________
City/State/Zip_______________________________________________ Phone _____________________________
Email ________________________________________________________________________________________
____________________________________
Participant or Parent / Guardian Signature
____________________________________
Date Volunteers must be at least
Volunteers under the age of 18
Volunteers under the age of 16
8-years-old to participate in
must have a signed Volunteer
must be accompanied by an
activities of the Regional Food
Permission Form in order to
adult over the age of 21 in
Bank.
participate.
order to participate.
RELEASE FOR THE UNIVERSITY OF OKLAHOMA
On this ___ day of _____________, 20__, I certify that I am the Legal Representative of ____________________________________,
(Minor’s Name)
hereinafter (“Minor”), of __________________, ______, and I have full authority to and do give permission for Minor to participate
(Home Town)
(State)
in ______________________________, hereinafter (“the Event”), to be held at the University of Oklahoma (“the University”).
University and Event Rules. I acknowledge that I have read the University’s rules stated herein or as otherwise advised at the time of
the Event, and as published on the University’s websites, www.judicial.ou.edu and www.ou.edu/home/misc.html, and understand and
agree to abide by all University and Event rules and policies. Failure to comply with these rules or any other rule established by the
Event may result in Minor’s immediate removal from the Event. I waive any claim for refund or any other contract right upon
removal. I certify that I have read and understand the Event rules and have explained said rules to Minor. I understand and agree to
notify the Event supervisor, Stephanie Peruttzi (Aquatics Coordinator) at 405-325-4837 immediately of any injuries Minor sustains as
a result of the Event and of any inappropriate behavior Minor experiences related to the Event. I also understand and agree that if any
issues of sexual misconduct, harassment or assault occur, I will immediately report those to both the Event supervisor Stephanie
Peruttzi (Aquatics Coordinator) at 405-325-4837 and the University’s Sexual Misconduct Officer at 405-325-2215 or
www.ou.edu/home/misc.html. Initials: _____
Talent Release. I understand that the University often produces promotional material relating to its programs. I understand that as a
participant at the Event, Minor may be included in videotapes or photographs taken during the Event. Therefore, without reservation
or limitations, I, in my own behalf and on behalf of the Minor, hereby assign, transfer and grant to The University of Oklaho ma, its
successors, assignees, licensees, sponsors, any television networks, and all other commercial exhibitors the exclusive right to
photograph and/or videotape the Minor and to utilize such videotapes and photographs and Minor’s name, face likeness, voice and
appearance as a part of the Event, in advertising and promoting the Event or in advertising and promoting similar future events at no
charge. Initials: _____
Medical Authorization. As parent and/or legal guardian of Minor, I hereby give consent and authorize said Event, the University and
its agents, representatives and employees to secure emergency medical treatment for Minor while Minor is in attendance at the Event
held at the University and that I am responsible for any and all costs associated with the transportation and treatment. I certify that if
my child has any special medical considerations, including food or other allergies, I have communicated those in writing to the Event
supervisor. Initials: _____
Transportation. I certify and agree that I am to pick-up and drop-off Minor only at the designated places and times. Should I fail to
timely pick-up Minor at the designated area, I understand OUPD may be contacted for arrangement of proper care of minor. Failure to
timely pick-up Minor may result in his/her immediate withdrawal from the Event. Initials: _____
Release and Waiver. I, for and on behalf of Minor, myself, my and Minor’s personal representatives, heirs, assigns and next-of-kin,
hereby release, waive, forever discharge, indemnify and covenant not to sue the Board of Regents of the University of Oklahoma, its
officers, members, employees, volunteers, agents and representatives for any and all loss, damages, claim, demand, action or right of
action, arising from or by reason of any injury resulting or to result from participation in the Event. I, for and on behalf of Minor,
myself, my and Minor’s personal representatives, heirs, assigns and next-of-kin, agree to hold harmless, defend and indemnify, for any
and all loss, damages, claim, demand, action or right of action, arising from or by reason of any injury resulting or to result from
participation in the Event. This contains the entire agreement between the parties hereto and all terms are contractual and not a mere
recital. I further state that Minor and I have each carefully read the foregoing Release and Acknowledgement as his/her own free and
voluntary act. I am at least eighteen years of age and sign this Release and Waiver voluntarily.
Parent/Guardian Printed Name
/____________
Relationship
___________________________________________/_________
Signature
Date
Address of Parent and/or Legal Guardian:
________________________________________________________________________________
City__________________________________State___________________Zip_________________
Home Phone: ______________________________Work Phone: __________________________________
Cell Phone: ________________________________ Email address: ________________________________
Emergency Contact other than parent or guardian if they cannot be reached:
Contact: ______________________________________________________
Phone: __________________________________________________________
Any questions regarding this form should be directed to the Event supervisor, Stephanie Peruttzi (Aquatics Coordinator)
at 405-325-4837.