SixThirty3 Student Ministry

Please fill out this form in its entirity. All fields marked with an * are required fields and must be filled out. Any comments, questions, or additional information may be left in the comment box at the bottom of the form.

Date of Birth

School Information

Mailing Address

Health History & Information

Please read the following very carefully!!!

I am aware that my child’s participation in all youth related activities through August 31, 2010 could involve the risk of injury to my child. I hereby agree to let my child participate and to hold First Baptist Church of Homestead harmless from any and all liability actions, courses of action, debts, claims, or demands of any kind and nature whatsoever which may arise by or in connection with my child participating in any activities. Because of the risks involved, I will encourage my child to follow the instructions of the supervising adults. My permission is granted for supervising adults to obtain medical and surgical treatment as may be needed in the judgment of the treating physician for my child by a physician chosen by the church chaperone. I also understand that, as a participant, my child may be photographed or videotaped during church sponsored activities and these photos/videos may be used in promotional materials and/or the church website. I am signing this of my own free will. By typing my name in the following field, I am agreeing to these terms.