Parent/Legal Guardian *

First Name

Last Name

Parent/Legal Guardian Phone Number *

(###)

###

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Birthdate *

MM

DD

YYYY

Emergency Contact Phone Number *

(###)

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Rules of Dismissal *

a) Pick-up is 5:45-6pm from the Family Life Center/Gym (please no sooner if possible, however we understand things arise from time to time.) b) teachers will remain with students until parents pick up. c) the car sign (given the first day) should be visible on the dashboard. d) parents will enter the breezeway from 4th street and remain in their vehicles and their child will be escorted to them by an adult volunteer. e) cars will exit towards 3rd street

I have read and agree to the Rules of Dismissal.

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. *

I agree

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 Agree

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. *

I Agree

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. *

I Agree

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.). *

I Agree

Dates *

(dates are subject to change) Wednesdays 3:15-6pm First semester : 9/10/25 - 12/3/25 (or 12/10/25 if the Christmas Cantata is later.) Break for Thanksgiving Second semester: 2/4/26-4/29/26 Break for Spring Break All Choirs sing in the Christmas Cantata : date TBD (12/7/25 OR 12/14/25?) -Kinder - 3rd grade choirs sing on Palm Sunday : 3/26/26 -4th/5th grade choir leads worship : 4/26/26

I have read and agree to the program's dates.

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. 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.

I have discussed these terms with my child and we agree to abide by the Rules of Respect.

Disciplinary Actions *

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.

I have discussed these disciplinary actions with my child and we agree to abide by them.