Parent/Legal Guardian
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First Name
Last Name
Email Address
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Parent/Legal Guardian Phone Number
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(###)
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Street Address
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City
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Zip
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State
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Child Name
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Gender
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Male
Female
Birthdate
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MM
DD
YYYY
Your Child's T-Shirt Size
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Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Allergies/Medications/Special Needs
Emergency Contact Name
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Emergency Contact Phone Number
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(###)
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Relationship To Student
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My Child Has Permission To Arrive To The Church Via
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Church Bus
Bicycle/Walking
Adult Parent/Guardian
Other(If This Option Is Chosen, You MUST Explain)
Other
My Child Has Permission To Depart The Church Via
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Walking/Bicycling
Adult Parent/Guardian
Other
Other
Rules of Dismissal
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a) Students will be gathered at closing time (6:00pm) in the Family Life Center b) teachers will remain with students until parents pick up c) drive-thru – parents will remain in their vehicles and their child will be escorted to them by an adult volunteer
I am the Parent/Legal Guardian of the child listed on this registration, and 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.
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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.
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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.
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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.
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First Baptist Church Valley Mills has my permission to post pictures of my child(ren) via group pictures, videos, and other "digital media" to fbcvm.org and social media platforms(Facebook, Instagram, etc.).
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Dates
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(dates are subject to change)
Sept. 11th -Dec. 11th for 2024 fall semester
Jan. 15th- TBD for 2025 spring semester
Rules of Respect
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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. If child's electronics, games, cards, or toys are not left in their backpacks during playtime, there is a risk that they could get damaged or lost, and FBCVM and its staff and volunteers are not responsible for these damages/losses. If these items are seen during class times (choir, Bible study) they will be taken up and returned at end of the program day. Your child must agree to report to the teachers and leaders if they observe another student not following the rules of respect.
Disciplinary Actions
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a) first offense of the day – time out – with an adult volunteer b) second offense of the day – parent can be called for pick up c) second time parent is called for pick up – two week suspension – after suspension parent will be called on the first offense and suspension for the rest of the semester.
*If the first offense (or any offense thereafter) is a physical altercation with another student, parent can be called immediately for pick-up.
In lieu of a physical signature, please type your full, legal name in the box below.
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