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Pioneer Club on-line registration form

Use this convenient form to register your child for Pioneer Club (use one form PER CHILD).

* Required Fields

*Child's Name (first and last):
*Child's Age:
*Child's Grade (last grade completed)?:
*Parent(s)/Guardian Name(s):
Parent email:
*Parent(s)/Guardian Phone # (xxx-xxx-xxxx):
*Emergency contact name:
*Emergency contact phone # (xxx-xxx-xxxx):
*Child street address:
*Child city/state/zip:
Church currently attending (if any):
Allergies (if any):
Medication(s) we should know about:
Medical conditions or other info we need to know:
Please contact me, I have other info and/or questions:
Your typed signature below indicates that you grant permission for First Baptist Church, Wellsboro to publish photos, videos, or voice recordings of your child taken in relationship to the activities of this children's ministry for promotional and/or informational purposes only.
SPECIAL COVID-19 STATEMENT - PLEASE NOTE THE FOLLOWING:
We plan to take the following actions to make the Pioneer Club environment safer for participants but WE CANNOT GUARANTEE complete safety or prevention of virus transmission. Your typed signature below is your acknowledgement that you a) understand what measures we plan to implement, b) acknowledge that these measures may be insufficient to prevent transmission of the coronavirus, c) consent to have your child participate in First Baptist Church's Pioneer Club, and d) that you will hold harmless First Baptist Church, it's officers, employees, and volunteers in the unfortunate event that your child(ren) contract COVID-19 and develop any of its complications. Further, you agree that if a child or ANYONE ELSE in your household is symptomatic of COVID-19 (e.g. fever/chills, cough, trouble breathing/shortness of breath, loss of taste or smell), you will keep ALL children from your household home and not bring them to Pioneer Club until such time as a physician clears them to return.
First Baptist Church plans to...(1) have daily temperature checks when children arrive, (2) make hand sanitizer available and encourage its use when children arrive and before snacks, (3) promote (but not guarantee) physical distancing during activities WHERE PRACTICABLE, and (4) have kitchen staff wear gloves, masks and/or face shields to prepare snacks.
*By typing my FULL NAME below, I certify that I am the parent or legal guardian of the child being registered, that I have the legal authority to sign this document, and have read and consent to the publishing of photos, videos, or voice recordings of my child, as well as all of the above COVID information, and agree to have my child(ren) participate in First Baptist Church's Pioneer Club.:
After you hit "SEND", in a few minutes you should receive a confirmation email at the email address you've given on this form.
*Authentication:
*7 + 4 =	Enter the correct answer to the math question.
Please click the Send button only once.

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