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FBC Waiver

Participant Information

Parent/Guardian #1

Parent or Guardian #2

Family Physician


In the event of an emergency, give the name and phone number of friends or relatives we can contact who will know how to reach parents or guardians. You MUST complete this information.

Permission and Release

Medical Treatment Permission

My permission is granted for the staff members or the designated/approved church representatives of FBC Hot Springs (FBCHS) to obtain necessary medical attention in case of sickness or injury to my child. I, the undersigned, do hereby verify that the above information is correct and I do hereby release and forever discharge all sponsors and First Baptist Church Hot Springs, and its staff/representatives, from any and all claims, demands, actions, or cause of action, past, present or future arising out of any damage of injury while employed by or participating in FBCHS events. The rights, powers, and authority of said representatives to exercise any and all of the rights and powers herein granted shall commence and be in full force and effect on the date listed below, and such rights, powers and authority shall remain in full force and effect thereafter until revoked by me in writing.

Photos and Social Media: At all children’s ministry events, digital pictures are taken for the sole purpose of promotion. I understand that my son/daughter’s picture may be used on our website or publications to promote FBCHS events.

Transportation Permission: The undersigned does also hereby give permission for my child to ride in any vehicle driven by a licensed ADULT chaperone while attending and participating in children & youth’s activities sponsored by First Baptist Church Hot Springs. My child and I understand that SEAT BELTS MUST BE WORN AT ALL TIMES during transportation.