Sunday School Registration Form
FBCC @ Pearland
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mom's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Dad's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Relationship
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Emergency Medical Facility
*
Please Select
Neighbors Emergency Center (11130 Broadway St. Pearland, TX 77584)
Houston Methodist Emergency Care Center in Pearland (11525 Broadway St.
Pearland, TX 77584)
Any Allergies, Medical Conditions or Other Concerns?
*
Yes
No
Please give details
Do you want to add something about your child?
Please upload a profile picture of the child
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of
I, undersigned, agree with the following statements:
*
I am the parent/guardian of the child indicated above.
I do hereby authorize emergency medical, dental, health or hospital services be rendered to my child upon consent of a Fort Bend Community Church staff member or designated volunteer. The purpose of this authorization is to permit my child to receive emergency medical attention when needed while involved in the activities connected with Fort Bend Community Church's Children's programs when I or my emergency contact is unavailable to give such consent.
I give my permission for FBCC to take my child's pictures and post or print them to appear among other ministry-related photos as long as there is no identifying information shown.
I, the undersigned, will not hold FBCC leaders or church representatives liable for any injuries sustained by my child while on the premise of FBCC. My signature below indicates my willingness to take full financial responsibility for any and all medical rendered for the named participant. My signature also serves to indicate my willingness for my health insurance company to be billed for any and all medical fees and services deemed necessary.
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
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