DNOW 2023 Registration
February 17th-19th | $70 | Fill out the form carefully for registrations. For scholarship information please contact Jo Ann in the church office before attempting to register. You can contact her at 940-692-4420 or joannl@faithwf.com.
Student Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Grade
*
Please Select
7th
8th
9th
10th
11th
12th
Parent Name
*
First Name
Last Name
Parent Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Phone Number
*
Please enter a valid phone number.
Student Phone Number
Please enter a valid phone number.
T-Shirt Size
*
Please Select
Small
Medium
Large
XL
2XL
3XL
4XL
Method of Payment
*
Online Registration
Pay-in-person
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Medical Release Form
This medical release form is required for ALL Faith Baptist Church Student Ministry events in 2023. If any of the information changes, it is the parent/guardian's responsibility to update the information through the church office.
Student Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
Date
Age
*
Gender
*
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Secondary Contact in case of emergency
*
First Name
Last Name
Relationship to student
*
Phone Number
*
Please enter a valid phone number.
Please supply the following information:
Submit
Medical Insurance Company
Group #
Policy #
Company's Adress
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company's Phone Number
Please enter a valid phone number.
Attach photo of insurance card (front)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Family Physician's Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Physical Limitations (Asthma, diabetes, allergies, etc.) and/or special instructions (allergic to certain meds, rare blood type, food allergies, wears contact lenses, etc.)
List ALL medications taken on a regular basis and/or any brought with you. (Prescription meds MUST have a pharmacy label and name of doctor.)
Any other medical information (operations, injuries, etc.) you would like us to be aware of?
Should be Empty: