Hampton Falls First Baptist Church
3 Lincoln Avenue, Hampton Falls, NH 03844
Phone: 603-926-3724 ◊ Fax: 603-926-4080 ◊ Email: dodom@hffbc.org

Sunday School Registration

* Last Name of Youth
* First Name of Youth
* Address
* City
* State
* Zip
* Age
* Home Phone
* Parent/Guardian Information  
* Parent or Guardian
* Work Phone Number
* Parent / Guardian Home Phone
* Email
*

Medical Info

* Allergies / Medical
* Youths Doctor
* Youths Doctor Phone Number
* Insurance Company
* Policy Number
* Emergency Contact
* Emergency Work Phone
* Emergency Home Phone
Other Info

Medical Release

(We) (I) hereby grant permission to First Baptist Church of Hampton Falls to secure medical care as (above) child may require including examination, treatment, and immunization. This permission is conditional upon the understanding that in the event of serious illness or the need for operation and/or major surgery, Hampton Falls Baptist Church, guardian, will use all reasonable efforts to contact me. Failure in such efforts, however, should not prevent Hampton Falls Baptist Church, guardian, from providing such emergency treatment as may be necessary for his/her best interest.


Release of Liability

By signing this Release, I do for myself and the above-named youth, release Hampton Falls First Baptist Church, it’s members, officers, directors, pastors, youth workers, agents, and employees from any and all liability for all losses, damages and personal injuries to myself and to the above-named youth resulting from any actions or inaction, or other cause whatsoever in connection with the above-referenced activity whether related to the emergency medical treatment referenced above or whether related to any other matter related directly or indirectly to the scheduled activity and any transportation in connection with such activity. By signing this Release, I specifically and additionally intend to release Hampton Falls First Baptist Church, it’s members, officers, directors, pastors, youth workers, agents, and employees from liability for all losses, damages and personal injuries to myself and to the above-named youth. I understand that the Hampton Falls First Baptist Church, it’s members, officers, directors, pastors, youth workers, agents, and employees will not bear liability for the consequences of the student’s negligence or oversight. I have read and understand the preceding paragraph, and voluntarily sign this Release on my behalf and on behalf of the above-named youth.


Photo Permission

Permission to use child's picture on web site (no names will be used)?



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