Campfire Registration 22-23

Student's Name

Student's Birthday

Students Grade

K 1st 2nd 3rd 4th 5th

Guardian's Name

Guardian Email

This address will receive a confirmation email

Guardian's Phone

Address

Will your child ride the bus?

Yes No

Secondary Emergency Contact Name

Secondary Emergency Contact's Phone

Approved for Pickup(First & Last Name as it appears on ID)

Please List Any Allergies or Medical Information we should be aware of:

I wish for my minor child to participate in the activities of the Children’s Program or Youth Group of the First Baptist Church from August 2022 to September 2023. I understand that these activities may take place at the church or other locations and may require that my child ride in the church van/bus or private volunteer-driven vehicles. As a condition of him/her being allowed to participate in these activities, I hereby release and discharge First Baptist Church of Stinnett, its staff members and volunteer workers from any and all claims for personal injury or property damage that my child may suffer as a result of their participation in these activities.I hereby warrant and represent that my child is physically and mentally fit and capable of taking part in such activities. I am not aware of any medical condition of my child that would render it inappropriate for him/her to participate in any such activities. I make this warranty and representation on the basis of advice given to me by a duly licensed medical doctor within the last twelve months, and I know of no change in the medical condition since receiving such advice. Should any change in my child’s medical condition occur that would affect my child’s participation in the activities of the children’s program I will notify the church.I agree to direct my child to cooperate and conform to directions and instructions of the supervisory personnel in charge of activities. I understand that if my child does not behave appropriately, they will not be allowed to participate.Should it be necessary for my child to have medical treatment while participating in these activities, I hereby give the adult supervising the activity permission to use their judgment in obtaining medical treatment. I agree that in the event my child is injured as a result of his/her participation in church activities (including transportation to/from the activities), recourse for the payment of any resulting hospital, medical or related costs and expenses will first be had against any accident, hospital or medical insurance or any available benefit of mine or my spouse. I agree that in the case of medical insurance or any available benefit of mine or my spouse does not cover the cost of expense or if I or my child does not have medical insurance, then I or my spouse will be responsible for the cost of the expense and will not hold First Baptist Church, its staff members, or volunteer workers responsible for any of the cost.I hereby authorize the making of photographs, motion pictures, videotapes, recordings, or other memorializing of such activities and my child’s participation therein, and the publication or other use thereof. I hereby waive any right to compensation therefore or any right that he/she/I otherwise might have to limit or control such making or use. By Typing your name below this is acting as an electronic signature to adhere to all of the above policies and liabilities.

Agree

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.I further acknowledge that First Baptist Church Stinnett cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I attest that my family:*not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.*have not traveled internationally within the last 14 days.*have not traveled to a highly impacted area within the United States of America in the last 14 days.*do not believe we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.*have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.*am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. By Typing your name below this is acting as an electronic signature to adhere to all of the above policies and liabilities.

Agree

Campfire Registration 22-23

Description

Please Fix the Following