Adventure Friday Registration Form

Adventure Friday Registration Form
Faith Community Bible

219 N. Harvey
Common Ground

120 N. Burrton Ave.
STUDENT INFORMATION
Child’s Name

First NameLast Name
Child's Preferred Name
Male / Female
My child will be attending:
Parent/Guardian

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Are Work Calls Allowed?
E-mail
example@example.com
Parent/Guardian

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Are Work Calls Allowed?
E-mail
example@example.com
If Multiple kids write each here:

Name:

Preferred Name:

Birthday ________ Age _____ Current grade ________

Preferred Name:

Birthday ________ Age _____ Current grade ________

Preferred Name:

Birthday ________ Age _____ Current grade ________

Preferred Name:

Birthday ________ Age _____ Current grade ________

Preferred Name:

Birthday ________ Age _____ Current grade ________
1st Emergency Contact.

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
2nd Emergency Contact.

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any Food Allergies? List
Other Allergies? List
Medical Concerns? List

Allowed to pick up Child (List additional people who may pick up your child )

Rows	Full Name	Contact Number
1
2
3
4

If someone is to pick up your child that is not listed call the numbers to inform staff

Permission for transportation during Adventure Friday

Rows	FCBC to Common Ground 12:00 p.m.	August 16, 2024 – May 16, 2025	Yes, I give permission	No, I do not give permission
In a vehicle with volunteer
walk by themselves
walk home by themselves
Walk with volunteers
Picked up by persons listed in registration form
Common Ground to home Any time after 12:00 p.m.

I, the legal guardian of ________________________________________, give permissionfor transportation for the above activities.
Date

MonthDayYear
Date
How did you hear about us?
Should be Empty: