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FAITH IN ACTION! INC (FIA) Programs Registration Form
Please complete this form for ALL FIA PROGRAMS/PARTNERSHIP PROGRAMS
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FIA Programs (check all that apply)
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FIA Gospel Performing Arts Starts January 7, 2023
FIA Community Performing Arts Starts January 7, 2023
FIA Young Artist (Dance for ages 4 - 9). Starts February 2023.
Burlington County Mentoring Program (BCMP) - February 2023
Teen Leadership Program (Men about Business and Ladies of Distinctive Elegance) March 2023
FIA Summer Performing Arts, Science, Mentoring, & Technology Camp July 2023
Work Readiness & Education (ongoing)
Willingboro NAACP - ACT-SO Program Grades 9 - 12 starts January 11, 2023
FIA DISCOVERY DATE January 28, 2023 (FREE)
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Referral Source: How/Where did you hear about us?
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Participant Name
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Your answer
Address
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City/State/Zip Code
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Your answer
Telephone Number
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Your answer
Age
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Your answer
Birthdate:
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MM
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DD
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YYYY
Gender
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Female
Male
Race
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American Indian or Alaska Native.
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White or Caucasian
Biracial
Other
Current Grade or Highest Level of Education Completed
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Your answer
School
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Your answer
Participant Email
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Your answer
Parent/Guardian Name (if a minor)
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Your answer
Telephone/Address (if different from above)
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Your answer
Parent/Guardian Email
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Your answer
Emergency Contact Name and Phone Number
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Relationship to Child
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Any Special Needs or Interests? (Write Here)
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