CROSSOVER - First Baptist Church, Madisonville

We are taking the time to understand “tweens” in the world today, giving them a safe place to have fun and engage with each other. Preteens are in a unique stage in life. They act, think and learn differently. Our leaders make sure the students have fun, feel safe and deepen their faith before they jump into a youth group. We meet each Wednesday night from 6:00 – 7:45, August – May. Crossover is a large group/small group format and is located in the upstairs room above the FBC office. If you have questions or would like more information please contact Vicki Hawkins at vicki@fbcmadisonville.org.

Name*
First Last
Age*
Birth Date*
Date Format: MM slash DD slash YYYY
Grade*
Gender*
- Male
- Female
Parent/Guardian Name*
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell/Pager
Email
Name and Phone of Nearest Relative*
Family Home Church
My child may ONLY leave to go home with the following people:*
Medical Consent:
*The below information releases FBC of medical liability and also gives permission for child to participate in on/off campus activities each year.
Allergies (Food, drugs, stings, bites, other):
The above named participant and the legal custodian thereof, hereby consent to the participation in the before-referenced activity conducted under the sponsorship of First Baptist Church, Madisonville, TN, an incorporated organization; its agent, servant, and member. In making such consent, participant and custodian acknowledge that they understand that there are risks to both persons and property associated with engaging in such activity, and they hereby consent to assume such risk.

In consideration of granting First Baptist Church, its agents, servants, and members for the participation in such activity by participant and custodian hereby, release and exonerate First Baptist Church, its agents, servants, and members from any and all liability of every nature and kind pertaining to such activity or the participation therein by participants. Participant and custodian expressly covenant not to sue and do herby waive and relinquish whatever right either may have or which otherwise might accrue against First Baptist Church, its agents, servants, and members by virtue of the sponsorship and supervision of such activity and the participation therein by participant.

Participant and custodian herby authorize and consent to any x-ray examination, anesthesia, medical or surgical diagnosis or treatment, and hospital care to be rendered to participant under the general or special supervision, and on the advice of a licensed physician, surgeon, anesthesiologist, dentist, or other qualified medical personnel acting under their supervision.

The consent, waiver, and release provisions hereof shall remain in full force and effect until written notice of revocation or withdrawal is received by First Baptist Church at its office of 139 College Street, Madisonville,, TN 37354.
Parent/Guardian Signature (Type your name)*
Date*
Date Format: MM slash DD slash YYYY

Medical Consent: