First Baptist Church At The Villages

Parent/Guardian Information

Parent/Guardian Name (required)

Address (required)

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number (required)

Alternate Phone Number

Email (required)

Emergency Contact Information

Emergency Contact Name (required)

Phone Number (required)

Dismissal

I authorize the following responsible persons to pick up my child from FBCATV's 5 Day VBS program. I understand that all persons authorized must be 18-years of age or older and provide driver's license identification.

Name of authorized pickup person (required)

Phone Number (required)

Name of additional authorized pickup person (optional)

Phone Number

Name of additional authorized pickup person (optional)

Phone Number

Name of additional authorized pickup person (optional)

Phone Number

Parental Consent

I hereby consent to let my child participate in VBS at FBCATV!! It is understood that every precaution will be taken for the safety and well-being of my child, but in the event of accident or sickness, Child Evangelism Fellowship and First Baptist Church At The Villages, its staff and its volunteers are hereby released from any liability.

Parent's Name

Name of Parent/Guardian providing consent (required)

Signature

Today's Date

By submitting this form, I give consent to First Baptist Church At The Villages of the child above.

Parent/Guardian Information

Child Information

Emergency Contact Information

Dismissal

Parental Consent

Service Times

Contact Info