Kid’s First Time Visitor Form Child's Name * First Name Last Name Child's Gender * M F Child's Birthdate * MM DD YYYY Parent's Name * Child's Grade * Preschool - 5th Grade Not of School Age Pre - K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Parent's Phone * Country (###) ### #### Parent's Email * Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Does the child have allergies, any medical or learning disabilities? If so, tell us. * Medical Release: I hereby authorize FCFC staff to call an emergency ambulance in case of accident or acute illness and to arrange necessary emergency medical and/or surgical care, in the event I am not immediately available. It is understood that a conscientious effort will be made to notify me (the parent or guardian) before such action will be taken. Any qualified physician called by FCFC staff may treat and do whatever necessary for the health and well-being of my child. I also agree to accept full responsibility for all costs of any above-mentioned medical/surgical service. I Accept Child's First Name Child's Last Name Child's Gender ... Child's Birthdate Child's Grade Not of School Age Parent's First & Last Name Parent's Phone Number (___) ___-____ Parent's Email Home Address Apartment Number City State Zip Code Does the child have allergies, any medical or learning disabilities? If so, tell us. Medical Release: I hereby authorize FCFC staff to call an emergency ambulance in case of accident or acute illness and to arrange necessary emergency medical and/or surgical care, in the event I am not immediately available. It is understood that a conscientious effort will be made to notify me (the parent or guardian) before such action will be taken. Any qualified physician called by FCFC staff may treat and do whatever necessary for the health and well-being of my child. I also agree to accept full responsibility for all costs of any above-mentioned medical/surgical service. * ... Media Release: I voluntarily release my child's appearance, and/or story for use in the production of television, video, radio, and/or printed products by FCFC including photos posted on the web. I agree that I will not receive any compensation or other consideration. I fully release FCFC, and all other persons, corporations and associations form any and all claims and causes of actions that I may presently have or may have in the future relating to my child's appearance in the above-mentioned projects. * I Accept Thank you!
