FBC 2017-2018 Children and Youth Registration Form
Fill out the form to register your child for FBC's educational ministries.
Child's Name
*
First Name
Last Name
Birth date
*
/
Month
/
Day
Year
Date Picker Icon
Current grade
*
Parent's Name
*
First Name
Last Name
Parent's Name
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Primary Phone Number
*
-
Area Code
Phone Number
Whose number is this?
*
Ex. "Mom's Cell," "Dad's Work," "Grandma's Cell," etc.
Alternative Phone Number
-
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.
Emergency contact's name
First Name
Last Name
Emergency contact's phone number
-
Area Code
Phone Number
Register
Should be Empty: