Heritage Baptist Church Presents Firm Foundation Kids Club
2026-2027
Child's Full Name
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Please fill out one form per child.
Date of Birth (mm/dd/yyyy)
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade
*
Please Select
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Please choose one
Home Church
If Applicable
Address (Street/Box, City, Postal Code)
*
Parent Guardian 1
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First Name
Last Name
Main Phone
*
Format: (000) 000-0000.
Alternate Phone
Format: (000) 000-0000.
Email
*
example@example.com
Parent Guardian 2
First Name
Last Name
Main Phone
*
If no second guardian is listed type (123) 456-7890
Format: (000) 000-0000.
Alternate Phone
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Relationship to child
*
Phone Number(s)
*
Format: (000) 000-0000.
Health Information (Please list any allergies or important medical information or type None)
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Please note that due to limited resources and training, if your child has special needs or requires one-on-one attention, a conversation will need to take place with program leadership in order to determine whether we are able to accommodate your child's needs. Please reach out to the church with a request to be contacted by the Firm Foundation leadership team. Failure to communicate special requirements may result in your child being excluded from the program.
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I understand and agree to the above statement
I understand all reasonable safety precautions will be taken at all times by Heritage Baptist Church Firm Foundation Kids' Club and its agents during the club nights. I hereby give permission to the child listed on this form to attend Firm Foundation Kids' Club at Heritage Baptist Church, Yorkton, SK on Thursday nights. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Heritage Baptist Church, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
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I understand and agree to the above statement
Consent for Photography Release - Please choose one:
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I GIVE consent for the photographs taken at Firm Foundation Kids' Club meetings to be used for the promotion of the program I understand that this will involve pictures of the above mentioned student being publicized within the church. on website and places deemed acceptable by those involved leading the Heritage Baptist Church Firm Foundation Kids' Club.
I WITHHOLD consent for photography taken at Firm Foundation Kids' Club meetings to be used for the promotion of the program.
Additional Information
Please include any other information that you think the Firm Foundation team should know about your child.
Parent/Guardian Signature
*
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: