Emge Focus Point Registration Form

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Who: Emge Middle School Students 4th through 8th Grade

What: A non-denominational Bible based after-school program.

When: Thursdays, February 8 15, 22, 29 and March 7, from 2:35 - 4:30 pm. (5 Weeks)

Why: We teach the truth & hope found in the Bible. This basic foundation of faith will help children their entire lives.

How: Submit 1 online registration form below for each child attending or print and complete 1 paper registration form for each child and return to the Coordinator.

Student’s First Name *

Student’s Last Name *

Grade *

Teacher *

Parent/Guardian Name *

Street Address *

Home Phone Number

Cell Phone Number

Email Address *

Emergency Contact Name and Phone Number (2:30pm-4:30pm) *

Will your child be picked up, walk home, or go to Latchkey after Focus Point group? *

Walk Home

Be picked up

Latchkey

Required

Allergies/Special Concerns *

Yes

Required

If yes, please explain

I would like to:

Volunteer

Donate Snacks

Does your child have a bible at home?

Yes

Please check if you DO NOT want a photo of your child to be used in newspaper articles, newsletters, or on the Kids For Christ Website or facebook page.

By typing my name below, I give my child permission to attend the after-school Focus Point program. I understand I must confirm all Bible Study plans with his/her school teacher in advance. I assume all risks and hazards incidental to Bible Study participation. *

I agree to the statement above.

Required

Parent Signature *

This program is entirely voluntary and not affiliated with School District #175.

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