| *Participant's Last Name: |
__________________________________ |
| *Participant's First Name: |
__________________________________ |
| *Preferred Name for Name Tag: |
__________________________________ |
| *Parent/Guardian Name: |
__________________________________ |
| *Current Grade: |
__________________________________ |
| *Birthday: |
__________________________________ |
| *Gender: |
Male Female (circle one) |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| Are you a member of this church?: |
Yes No (circle one) |
| Do you attend Church?: |
Yes No (circle one) |
| If so, where?: |
__________________________________ |
| *Allergies, Medical, & Special Needs: |
|
| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| Comments: |
|
| *T-Shirt Size: |
__________________________________ |
| Permission, Medical Release & Release of Liability: |
I give permission for him/her to attend D-Now with First Baptist Church Paducah. I also agree that FBCP and its staff and volunteers shall not be held liable in the event of an accident or injury. In addition I give permission for those individuals to render first aid as needed and to seek medical attention on my behalf. I assume all financial responsibility in such event and give permission to any medical facility to treat my child as needed. I also understand that group photos and pictures of the event may be posted on the church’s social media. I give permission for my child to be included in such posts. (circle one) |
| Crossings Release Form: |
https://waiver.smartwaiver.com/e/AFnLkEqV4CnPHt6fvtnJtk/ (circle one) |
