Please enter the grade your child completed for the 2022-2023 school year. If your child has not begun school yet, please indicate the age of your child.
By checking this box, you give permission for your child ("participant") to attend and participate in Vacation Bible School activities at First Baptist Church of Opelousas from June 25, 2023, through June 29, 2023.
In consideration of First Baptist Church of Opelousas allowing the Participant to participate in children's ministry activities and childcare, I, the parent or guardian, do hereby release, forever discharge and agree to hold harmless First Baptist Church or Opelousas, its pastors, directors, employees, volunteers, and teachers (collectively herein the "Church") from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the parent/guardian and Participant while involved in the children's activities and childcare. I, the parent or legal guardian, of this Participant hereby grant my permission for the Participant to participate fully in children's ministry activities and childcare, including trips away from the church premises. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.
Please list any known medical conditions (asthma, diabetes, epilepsy, etc.), allergies (drug/medicine, food, and/or environmental) and the severity and type of reaction, and explain any other pertinent information about the participant (i.e., physical, behavioral, or emotional) that would be important for the adult leaders to know.
I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital or emergency care facility. The parent or guardian shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.
List all medications the child will take during this VBS event. This includes any prescription, non-prescription medications, herbal supplements and vitamins. Any participant under the age of 18 is required to give ALL MEDICATIONS to the adult child leader in their original containers with complete dispensing instructions before the start of the event. Children are not permitted to carry any prescription or non-prescription medication and will be sent home at the parent/guardian's expense if they do.
Please provide the Medication Name - Dose - Treatment for - Dispensing Instructions (Example: Zyrtec, 5 mg, Seasonal allergies, take one pill daily in the morning with food)
If none are required, please type "None".
By answering "Yes", I agree that First Baptist Church of Opelousas may photograph and record my child/dependent’s likeness and activities (Images) during church-related activities. I grant the following rights to First Baptist Church of Opelousas: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. now existing or subsequently developed, on the church website and on the Internet, and worldwide in perpetuity for the purposes stated above.
I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 21 and have legal capacity to sign the release.