773-3123 x 107 ~ dbartley@maine.rr.com

Welcome to the Children's Channel. It's a place for children - ages Infant through 6th grade - to learn more about Jesus and become His disciple. We offer many programs at First Baptist Church to support parents in this goal.   Noah's Ark Park is a great place to come to on Sunday mornings.  Check out more information on other parts of our website.....

Child’s Name: ______________________________________Today's date:_____________________             

 Placement:__________________

Date of Birth: ____________________Parents names: _____________________________________

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Home Phone: __________________________Child's Nickname______________________________

Mom's Cell Phone: _____________________Dad's Cell Phone: ______________________________

Additional person in case of emergency: Name_____________________________________________

Phone:__________________________________   Relationship:______________________________

Child’s Address:___________________________________________________________________

Allergies/Medical concerns/Other information:______________________________________________

________________________________________________________________________________

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 I give permission for my child to participate in Children’s Channel activities on the grounds of First Baptist Church. 

 Signed: __________________________________________________________________________________________

 I give permission for my child to be photographed or videotaped for the Children’s Channel communications.

 Signed: __________________________________________________________________________________________

Can we contact you to give you more information?  ___Yes   ___No   Email address:_________________________________