Fields marked with * are required

[p]Our Roar VBS program is open for children in sr. kindergarten, up to those going into grade six.[/p] [p]If at any time you need help filling out the form please call the First Baptist Church Office at (519) 886-6530.[/p]

[h3]Parent / Guardian Info[/h3]

[h3]Secondary Emergency Contact[/h3]

[h3]Medical Info[/h3]

[h3]Pick-Up Person[/h3]

[h4]First Person[/h4]

[h4]Second Person[/h4]

[h3]Group Request[/h3] If you would like your child to be placed in a group with a specific friend, please enter their friend's name below, and we will do our best to accommodate!

[h3]VBS CD[/h3] [p]Would you like to purchase a VBS Music CD? The CD contains the VBS songs the children learn over the week. The cost is $10.00 per CD.[/p]

[h3]Friday Noon Time Lunch[/h3] [p]How many people will be attending the Friday noon hour BBQ luncheon? (There is no cost associated with the lunch)[/p]

[h3]Medical Consent[/h3] [p]I, [span id="full_parent_name"][/span], the parent or legal guardian of [span class="full_child_name"][/span], do hereby grant permission for said child to receive emergency medical care if:[/p] [p][ul] [li]Such care is deemed necessary by the adult supervisor having custody of my child at First Baptist Church.[/li] [li]The proposed medical treatment and procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain my personal consent would reasonably jeopardize the life, health or well being of the affected child.[/li] [li]I cannot be personally contacted.[/li] [/ul][/p]

[h3]Photo Consent[/h3] [p]I hereby authorize video and/or photographs to be taken of my child, [span class="full_child_name"][/span], for the purpose of identification, education or promotion:[/p]

[h3]Privacy Notice[/h3] [p]All information provided will be used solely by First Baptist Church staff and/or volunteers for the purposes of running the Roar VBS program. Information will be retained until the program has concluded, at which time this information will be destroyed. If you have any questions regarding how this information is used, please call the First Baptist Church Office at (519) 886-6530.[/p]