Name*
Date of Birth (mm/dd/yyyy)* January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
, AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Phone*( ) -
Email*
Yes
No
Member of another Church? If so, list church and how long have attended.
Special Interests / Hobbies?
Option 2
If yes, please explain:
Basic
Fluent
Any situations you would be uncomfortable with or unable to do (i.e. assisting with toileting, aggressive behavior, speech impairments, etc.)? Please explain.
Inclusion (buddy)
Self-Contained Class
Substitute
Other
If 'other' list area of service
What do you hope to achieve by participating in this program?
Do you have any preconceived ideas or expectations regarding this program?
I understand and agree to keep all information disclosed to me regarding the children and families confidential.
I release First Baptist Forney and its staff memebers from any and all liability in the event I am injured while performing my duties in this program.
I hereby grant First Baptist Forney permission for photography and/or videography to be used in church sponsored communications (i.e., newsletters, brochures, worship folders, video productions, advertisements, etc.)
Please read the following statements carefully and initial in the designated space indicating that you have read, understand and agree to the terms.
Signature - Type your name and date*
I have read, completed and understood the above, attached information. I have initialed the above authorization statements and agree to the terms designated in each statement.
