FMSM’s Back 2 School Bash Registration Form

Welcome To FMSM’s Family Registration

Important Notice: CHILDREN MUST BE PRESENT TO RECEIVE SCHOOL SUPPLIES AND HAVE AN ADULT SUPERVISION AT ALL TIMES
Parent/Guardian Information
First Name
Last Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email
example@example.com
Household Information
Primary Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone
This number is if we are not able to reach you concerning your child
Number of Adults
Number of Children
First Time Attending FMSM Back 2 School Bash?
Do you have children under 36 months that need diapers or pull ups?
Please note: A parent or guardian must complete this form. All Child(ren) MUST BE present. All information provided must be accurate.
1 Child Registration

Only able to register up to 3 children per household
Is this child being registered to receive school supplies only or diapers only?
Child 1 First Name
Child 1 Last Name
Child 1 Date of Birth

MonthDayYear
Date
Child 1 Age
Child 1 Grade (2026–2027)
2 Child Registration

Only able to register up to 3 children per household
Is this child being registered to receive school supplies only or diapers only?
Child 2 First Name
Child 2 Last Name
Child 2 Date of Birth

MonthDayYear
Date
Child 2 Age
Child 2 Grade (2026–2027)
3 Child Registration

Only able to register up to 3 children per household
Is this child being registered to receive school supplies only or diapers only?
Child 3 First Name
Child 3 Last Name
Child 3 Date of Birth

MonthDayYear
Date
Child 3 Age
Child 3 Grade (2026–2027)
Parent/Guardian Photo ID

Cancelof
DOCUMENTED PROOF SHOWING CHILD’S NAME

Check below what Document is being uploaded
Cancelof
How did you hear about this event?

Other (______________)
Do you need a voucher for food?
Electronic Signature
Date

MonthDayYear
Date
STAFF SECTION ONLY

(Attendees DO NOT go beyond this)
Staff Approval or Denial (Staff make sure child’s prove of documents are verified )
Staff Initials
Staff Notes (optional)
Should be Empty:

Welcome To FMSM’s Family Registration

Parent/Guardian Information

Household Information

1 Child Registration

2 Child Registration

3 Child Registration

STAFF SECTION ONLY