Alternate Emergency Contact
Please give details (name, address and phone number) of other persons who you authorize to collect your child/ren in your absence, while in the care of First Baptist Church VBS Program:
Are there any family situations we should be aware of? Eg: custodial issues, other matters (please specify)
If you do not want this information to be used for any other purpose other than children’s programs, please notify us in writing: Roxanne Karol c/o First Baptist Church, 84 Maple Avenue, Red Bank, NJ 07701
Permission to Participate in Program Activities
By submitting this form I consent to my child taking part in the approved program of activities for the First Baptist Church VBS Program
Permission to View Video Tapes and DVDs
I consent to my child viewing VHS tapes or DVDs rated (G) General.
I understand that all material will be previewed by a leader to check suitability.
Permission to be Photographed or Filmed
I give my permission for my child to be photographed or videotaped. I understand that the image may be displayed in the church publications, church buildings or website. I understand that as a precaution my child’s name will not be published or linked with photographs.
Confidential Medical Report
The information below is requested to assist in case of any illness or accident. This information will be held in confidence.
I authorize the leader/s in charge of the First Baptist Church VBS Program where it is impractical to communicate with me, to arrange for my child to receive such medical or surgical treatment as the leader/s may deem necessary at any time during the activities of the First Baptist Church VBS Program
I further authorize the use of Ambulance and/or anaesthetic by a qualified medical practitioner if in his/her judgement it is necessary. I accept responsibility for payment of all expenses associated with such treatment.
I appreciate that every care will be taken by the leaders and those connected with that group cannot be held responsible for personal injury, loss or theft of property affecting my child.