KIDS ADVENTURE PROGRAM
Ages 5 - 11
$10 per child or $30 max per family
July 7th to 10th
9:00AM to 11:45AM
Information received is confidential and is being gathered for the purposes of serving your Child while in the care of Fellowship Baptist Church Collingwood. Any medical information collected here serves to authorize Fellowship Baptist Church Collingwood, and its staff and volunteers, to obtain medical assistance in emergencies
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PARENT / GUARDIAN INFO
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact (In the event the primary contact can not be reached)
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Will an adult, not identified above, be picking up your child?
*
Yes
No
Name
First Name
Last Name
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CHILD'S CONTACT INFO
How many children will be attending KAP?
*
Please Select
1
2
3
4
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1st Child's Info
Name
*
First Name
Last Name
Age
*
Does this child have any severe allergies (bee stings, food, etc.) or will they be bringing any medication with them?
*
Yes
No
Please identify any allergies or medications and explain if they can self administer or how assistance can be provided.
Does this child have any physical, emotional, mental, or behavioral concerns or limitations that our staff should be aware of?
*
Yes
No
Please identify and explain
2nd Child's Info
Name
*
First Name
Last Name
Age
*
Does this child have any severe allergies (bee stings, food, etc.) or will they be bringing any medication with them?
*
Yes
No
Please identify any allergies or medications and explain if they can self administer or how assistance can be provided.
Does this child have any physical, emotional, mental, or behavioral concerns or limitations that our staff should be aware of?
*
Yes
No
Please identify and explain
3rd Child's Info
Name
*
First Name
Last Name
Age
*
Does this child have any severe allergies (bee stings, food, etc.) or will they be bringing any medication with them?
*
Yes
No
Please identify any allergies or medications and explain if they can self administer or how assistance can be provided.
Does this child have any physical, emotional, mental, or behavioral concerns or limitations that our staff should be aware of?
*
Yes
No
Please identify and explain
4th Child's Info
Name
*
First Name
Last Name
Age
*
Does this child have any severe allergies (bee stings, food, etc.) or will they be bringing any medication with them?
*
Yes
No
Please identify any allergies or medications and explain if they can self administer or how assistance can be provided.
Does this child have any physical, emotional, mental, or behavioral concerns or limitations that our staff should be aware of?
*
Yes
No
Please identify and explain
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CONSENT & ACKNOWLEDGMENT
I grant permission for photos and videos including my child to be taken and used by Fellowship Baptist Church for promotional purposes for the church. I understand my child’s name will not be used.
*
Yes
No
Would you be interested in hearing about other events at Fellowship Baptist Church?
Yes
No
FBC Privacy Policy
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