Parent's Night Out Consent Form

Child's Name *

Birthdate *

Allergies/Food Restrictions *

Parent's Name *

Mobile Phone *

Who will be picking up the child? *

Medical Release *

In the event of a medical emergency, I authorize the church staff/volunteers to seek necessary emergency medical treatment for my child(ren) if I cannot be reached immediately.

I agree

I disagree

Photo Release *

I grant FBC Saltillo permission to take, use, publish, and distribute photographs, video recordings, or digital media of the Minor named above.

I agree

I disagree

Signature *common.clear

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Parent's Night Out Consent Form