First Baptist Church
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Stage & Age
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FBC Kids' Medical Release Form
Parent's First Name
Parent's Last Name
Please List Two Emergency Contacts.
Child's First Name
Child's Last Name
Child's Birthday M/D/Year
Child's T-Shirt Size
Please list any allergies or medical condition we need to be aware of or write NONE:
Primary Physician Contact Information & Number
Insurance Company Information
Medications/dosage/time of day or write NONE:
E-SIGN BY TYPING YOUR NAME BELOW: I am the parent and/or guardian of said minor(s) above, hereby acknowledge that said minor(s) are under my care, custody, and control. I hereby give the said minor(s) my express permission to travel/participate in church sponsored events and functions of FBC Kids' of First Baptist Church of Snyder, Texas. In the event there arises an emergency requiring medical or surgical attention, I hereby consent and give permission to FBC Kids' of First Baptist Church of Snyder, Texas and it’s representatives, or any attending physician to make such decisions, and to perform such medical or surgical treatment upon said minor(s), which in their sole discretion, may be reasonable and necessary under the circumstances. I, the undersigned parent and/or guardian of said minor(s), do release, acquit, discharge, and covenant to hold harmless the said FBC Kids' of First Baptist Church of Snyder, Texas or its representatives from any and all actions, damages, and/or liabilities arising from the treatment of any sickness or accident incurred by said minor. It is the intention of this release that FBC Kids' of First Baptist Church of Snyder, Texas and its representatives incur no liability whatsoever while attending to the reasonable and necessary treatments, surgery and other medical needs that may, in their sole discretion, be needed by said minor(s). *E-SIGN BY TYPING YOUR FIRST and LAST
Website, Social Media, Publication, Video, and Photo Release. In an effort to be conscientious about online privacy, we are requesting photo releases from you allowing us to post images of your student(s) on the church website, social media and or FBC Kids' of First Baptist Church of Snyder, Texas publications to promote church functions and activities. Students generally will not be identified by name in any photos or text. However, please understand that others outside of church staff may tag your student(s). If there is ever a problem, please feel free to contact Children's Minister, Kasey Walker, anytime. Please check the following. * YES, I allow FBC Kids' of First Baptist Church of Snyder, Texas to post images of my student(s) on their website, social media or in church publications. No, my child's picture will not be taken, published, or shared. My child will not be in group/activity pictures and videos.
Please share any additional information about your child that you feel we at church need to know.
For additional children click here