Giddy Up Junction VBS 2019

Emergency Contact:

First NameLast Name
Relationship to Child:
Emergency Contact Phone:

Area CodePhone Number
Person other than parent authorized to pick up child:
Special Needs / Alergies / Concerns:
We encourage you to pack your child's snack if they have food allergies.

Name of 1 friend you child would like to be grouped with:
First Baptist Church Washington has permission to photograph/film the minor designated above in any manner or form for any lawful purpose associated with this VBS program?
Home Church
Parental Consent

I hereby consent to let my child participate in the event Giddy Up Junction! It is understood that every precaution will be taken for the safety and well-being of my child, but in the event of accident or sickness, First Baptist Church Washington, its staff and its volunteers are hereby released from any liability.
Child's Name of Consent:

First NameLast Name
Parent's Name:

First NameLast Name
By submitting this form, I give consent to First Baptist Church Washington of the child above
Should be Empty: