2026/2027 FBCE CHILDREN’S MINISTRY & CHOIR
Tuesday’s from 3:00-4:30 pm
Student's Information
Student's Name
First Name
Last Name
Age
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Name
School/Grade Level
Parent/Guardian Information
The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
The parents/guardian listed below will also be the primary emergency contact person.
Name
First Name
Last Name
Relation
Phone Number
-
Area Code
Phone Number
Name
First Name
Last Name
Relation
Phone Number
-
Area Code
Phone Number
Medical Information
Does the child have any allergies? If yes, please list them below:
Does the child have any current medical conditions? If yes, please list them below:
Authorization
I, the parent/guardian of this student gives authority to the staff of this Church to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
I confirm that all information given in this form is true, complete, and accurate.
Parent/Guardian Signature
Submit
Print Form
Should be Empty: