for Fine Arts Camp - First Baptist Church Temple

Fine Arts Camp Registration
Medical Waiver Form
and Parental Consent and Release Form
You must pay camp registration fee in order for your registration to be valid. Although you must complete a
Registration Form, Medical Waiver and Parental Consent and Release Form for each child, you may make one
payment, online, for all children involved. The cost is $20 per camper. Please click on the link at the bottom to
make your payment online. You may also make your payment at the church office. If you are having trouble with
this form, try updating your Adobe reader by going to adobe.com.
When we receive notice of your payment and completed Registration Form(s), Medical Waiver(s) and Parental
Consent and Release Form(s) we will email you a registration confirmation. If you do not receive an email
confirmation within the next two business days, call the church office at 254-773-6866.
We are required to have a completed Medical Waiver for each child attending. Because a Medical Waiver must be
attached to the child's Registration Form, YOU MUST COMPLETE A REGISTRATION FORM, MEDICAL
WAIVER FORM AND PARENTAL CONSENT AND RELEASE FOR EACH CHILD ATTENDING.
These three forms are below.
Fine Arts Camp Registration
Parent/Guardian Name:
Student Name:
Address:
Street
City
Zip Code
Email Address:
In an emergency, phone number you can be reached at 1)
2)
Please list any known allergies:
Select your child's size:
Youth T-shirt size:
S
M
L
XL
- Or -
S
Adult T-shirt size:
M
L
XL
Grade completed this year:
K
1
2
3
4
5
Are you actively involved in a local church?
Yes
No
Where?
First Baptist Church of Temple
8015 West Adams Ave. - Temple, TX 76502
254.773.6866
www.firsttemple.org
Medical Waiver
Age:
Name:
Address:
Grade Completed:
City:
Zip:
Parent/Guardian:
Phone-(H)
(W)
Emergency Contact:
(C)
Phone:
Medical Insurance Co. & Policy Number:
List any conditions you have, such as headaches, allergies, nervousness, etc.:
If at any time, during any activity you should require medical attention, list any special instructions which you might require, such as an
allergy to penicillin, having rare blood type, etc.:
Medical and Surgical Waiver
I. To be filled out by the parents or legal guardians of young people under 18 yrs. of age.
I,
, the parent and/or legal guardian of
, a minor, hereby
acknowledge that said minor, has my express permission to participate in the activities of the Student’s/Children’s Ministry of First Baptist
Church of Temple.
In the event there arises an emergency, necessitating medical or surgical attention, I hereby consent and give my permission to First Baptist
Church of Temple, or its representatives, or the activity sponsors, or any attending physician, to make such decisions and to perform such
medical treatments and/or surgery upon said minor which may in their sole discretion be necessary and proper under the circumstances.
I, the undersigned parent and/or legal guardian of
, a minor, do release, acquit, discharge and covenant to
hold harmless First Baptist Church of Temple, or its representatives, or the activity sponsors, or their heirs and assigns, from any and all
actions, causes of actions, damages, liabilities arising out of the treatment of any sickness or accident incurred by my said child while
participating in activities of First Baptist Church of Temple.
Parent and/or Legal Guardian
Date
(We will get your signature on the first day of Fine Arts Camp)
First Baptist Church of Temple
8015 West Adams Ave. - Temple, TX 76502
254.773.6866
www.firsttemple.org
Parental Consent and Release
In accordance with the child Protection Policy of First Baptist Church of Temple. To be completed by the parents or legal
guardians of students under 18 years of age.
I,
, the parent and/or legal guardian of
(Parent/Legal Guardian - Print)
(Child's Name)
a minor, hereby acknowledge that said minor, has my express permission to:
Participate in First Baptist Church Temple ministry events and be transported by church owned or non-church
owned vehicles in conjunction with the ministry events of First Baptist Church of Temple.
I also agree to fully release and hold harmless First Baptist Church of Temple, its ministers, employees and other workers,
paid or volunteer, or their heirs and assigns, from any and all claims, liabilities or causes of action which may arise from
the decision of the church, minister, worker, or other representative, to allow my child to be transported in conjunction
with his/her participation in the ministry events of First Baptist Church of Temple.
I also consent and give my permission for the use of: photographs, video and other forms of media of myself and/or my
child taken at First Baptist Temple ministry events to be used for the promotion of First Baptist Temple on all their
internet, social media sites, or printed material.
Signature of Parent and/or Legal Guardian____________________________________________ Date_________________
(We will get your signature on the first day of Fine Arts Camp)
Please click below to submit these forms by email. If you have an additional child or children to
register for Fine Arts Camp, please return to the Registration Form / Medical Waiver / Parental
Consent and Release page and complete one set for every child you are registering.
You will get a pop-up window asking you to choose the method to use to submit the forms. If this
causes you to have an error, feel free to contact Marianne at 254-773-6866 or
[email protected].
Submit by Email
You must pay for all camp registration fees in order for your registration to be valid. Although you must complete
a Registration Form, Medical Waiver and Parental Consent and Release Form for each child, you may make one
payment, online, for all children and camps involved. Please click on the link below to make your payment online.
First Baptist Church of Temple
8015 West Adams Ave. - Temple, TX 76502
254.773.6866
www.firsttemple.org
To use paypal , please click on this link. If it does not automatically talk you to the webpage,
copy and paste the link in your web browser.
PAY HERE