FBC 2021 Children and Youth Registration Form
This form is for FBC's educational ministries (Wednesday Nights and/or Sunday Mornings).
Child's Name
*
First Name
Last Name
Birthdate
*
/
Month
/
Day
Year
Date Picker Icon
Current Grade
*
This child is planning to attend:
Worship Service Nursery (9:00am-10:00am)
Children's Church Sunday Scoop (9:00am-10:00am)
Sunday Scoop (10:00am-10:30am)
Sunday School (10:30am-11:20am)
Wednesday Nights (6:00pm-7:30pm)
Parent's/Guardian's Name
*
First Name
Last Name
E-mail
*
Cell Phone Number
*
-
Area Code
Phone Number
Other Parent's/Guardian's Name
First Name
Last Name
E-mail
example@example.com
Cell Phone Number
-
Area Code
Phone Number
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternative Phone Number (for emergencies)
-
Area Code
Phone Number
Whose number is this?
Ex. Mom's Cell, Dad's Work, Grandma's Cell, etc.
Medical information we should be aware of (medications, food allergies, etc.)
*
Is anyone other than the parents/guardians listed above authorized to pick up your child?
*
Yes (please provide name and relation below)
No
Who is authorized to pick up your child?
First Name
Last Name
Relation to child
Do we have your permission to include pictures of your child in presentations, on our church website, or on social media.
*
Yes, you may include pictures of my child.
No, please do not include pictures of my child.
Anything else to note?
Register
Should be Empty: