Parent/Legal Guardian Information
Parent/Legal Guardian *
Parent/Legal Guardian
Parent/Legal Guardian Phone Number *
Parent/Legal Guardian Phone Number
Child Information
(The grade your child is going into/currently in)
Birthdate *
Emergency Contact Information(MUST be someone other than the Parent/Guardian)
Emergency Contact Phone Number *
Emergency Contact Phone Number
Arrival To/Departure From The Church
Rules of Dismissal *
a) Students will be gathered at closing time in the Family Life Center b) teachers will remain with students until parents pick up – parents will be given a pickup voucher for each child c) drive-thru – parents will be given a drive thru pick up voucher for each child. parents will remain in their vehicles and their child will be escorted to them by an adult volunteer
My child has my permission as his or her Parent/Legal Guardian to participate in all Wednesday afterschool activities at First Baptist Church Valley Mills. *
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 Wednesday After-School Activities. *
I voluntarily waive any claim against First Baptist Church Valley Mills, the volunteers, employees, and the owner/driver of the car or bus providing transportation to any event. *
In the event of an emergency, I hereby authorize an adult leader of these activities, 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 of my child(ren) via group pictures, videos, and other "digital media" to and social media platforms(Facebook, Instagram, etc.). *
Program Dates, Rules, and Expectations
Dates *
Fall Semester: Sept. 6 - Dec. 20 || Off Dates – Nov. 22 Spring Semester: Jan. 10 - May 15 || Off Dates - March 14
Rules of Respect *
My child will respect teachers, leaders, and volunteers. My child will follow directions, behave appropriately in class and on the playground. My child will respect other students. He/she will keep hands to self, will not call other children names, and will not bully other students. All of my child's electronics, games, cards, and toys need to be left in their backpacks. If they are not they will be taken up and taken to the office where the parent/guardian will need to pick them up. Your child must agree to report to the teachers and leaders if they observe another student not following the rules of respect.
Disciplinary Actions *
a) first offense of the day – time out – with an adult volunteer b) second offense of the day - sit out the rest of the day c) third offense of the day – call parent for pick up d) third time parent is called for pick up – two week suspension – after suspension parent will be called on the second offense and suspension for the rest of the semester.
Almost Done!