Children's FA Registration

KIDS FIRE ACADEMY REGISTRATION

Tsidkenu Kids Fire Academy
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
What church does student attend ?*
Parent or Legal Guardian's Information
Parent Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Is your child a former Kids FA Alumni?*

YesNo
Have you prayed with your child about this decision?*

YesNoPrayer Requested
What experience is your child expecting to gain from Fire Academy?*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.*

I agree
I choose to allow my child to partake in Kids Fire Academy at Tsidkenu Church as well as all requirements and outreaches involved and release all liability of Church Tsidkenu. *

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Tuition

If you would like to pay IN FULL by check or cash, please reach out to our FA Director, Tara Richey, at fireacademysandiego.com to make arrangements. You save $50 by paying in full. All payments are NON REFUNDABLE.
Other payment:

Cash or Check

Credit Card Payment:

Pay in Full

$200.00 Quantity

Payment Plan5 monthly installments of$ 90

$250.00 Quantity

2 or More Children

$500.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

KIDS FIRE ACADEMY REGISTRATION

Parent or Legal Guardian's Information

Tuition