Child's Name *

First Name

Last Name

Grade *

Pre K

Kindergarten

1st

2nd

3rd

4th

5th

6th

Emergency Contact *

First Name

Last Name

Phone *

(###)

###

####

Authorized Person To Pick-Up

First Name

Last Name

Secondary Authorized Person To Pick-Up

First Name

Last Name

Photo Release Waiver *

I hereby grant First Baptist Church of Hugo permission to use my child's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of First Baptist Church of Hugo and will not be returned. I hereby irrevocably authorize First Baptist Church to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my child likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the First Baptist Church of Hugo from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM THE PARENT OR LEGAL GUARDIAN OF THE CHILD THAT IS BEING REGISTERED.

Yes

No

Medical Waiver *

MEDICAL AUTHORIZATION My permission is granted for First Baptist Church of Hugo staff to obtain and/or authorize medical attention for my child in case of sickness or injury and to do all things for and in my/our name with full authority to sign all papers or documents. RELEASE I, undersigned, do hereby release, remiss and forever discharge First Baptist Church of Hugo, and its staff and sponsors for any and all claims, demands, actions or cause of action, past, present or future arising from any damage or injury while participating in all children events.

Yes

No

Typed Signature *

First Name

Last Name