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Ministry Team
Pastor
Minister of Music
Minister of Students
Schedule + Info
Schedule
Get Connected!
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Wednesday Children's Discipleship Program
FBCVM Student MInistry
Church Trac
Rental of our Facilities for Events
Home
Ministry Team
Pastor
Minister of Music
Minister of Students
Schedule + Info
Schedule
Get Connected!
Online Giving
Our Committees
Our Community
Wednesday Children's Discipleship Program
FBCVM Student MInistry
Church Trac
Rental of our Facilities for Events
FBCVM STUDENT MINISTRY
Parent/Guardian Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Student's Name
*
First Name
Last Name
Grade
*
6th
7th
8th
9th
10th
11th
12th
Birthday
*
MM
DD
YYYY
Allergies/Medications/Special Needs
*
Emergency Contact (must be a different person/phone number than what is listed above)
*
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Relationship to student
*
By clicking these check boxes, I agree that
*
I am the parent/legal guardian of the child listed on this registration, and my child has my permission to participate in (youth event)
I hereby release First Baptist Church Valley Mills and its directors, employees and volunteers from responsibility and liability for any injury or illness that my child may sustain during (youth event)
I voluntarily waive any claim against First Baptist Church Valley Mills, the volunteers, employees , and the owner/driver of the car , van, or bus providing transportation to and from (youth event)
In the event of an emergency, I give my permission to those in charge to stop any bleeding and administer first aid, and hereby authorize an adult leader of this activity, as an agent for me, to consent to any x-ray examination, medical, dental, or surgical diagnosis, treatment, and hospital care advised and supervised by a physician or surgeon.
First Baptist Church Valley Mills has my permission to post pictures/video of my child to fbcvm.org and social media platforms (Facebook, Instagram etc.) for promotional purposes
In lieu of signature, please type your full legal name in the box below
*
Thank you!