Permission / Medical

Youth Medical

First Baptist Church Youth Permission / Medical Form

All students are required to have one of the following documents on file in the church office to participate in a church function, activity, or trip. Please fill this out completely and the form on the following page and attach a copy of the front and back of your insurance card in an email to rob@firstmoultrie.org. Thank you!

mm/dd/yyyy
Include special medical needs or concerns such as asthma, allergies, conditions, dietary needs, medications, etc.