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Children/Youth Ministries Registration 2022-2023
FOR STUDENTS AGE 3 - 5 AND ENTERING GRADES K - 12
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Email
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Your email
Parent/Guardian Name #1(who resides with child)
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Your answer
Parent/Guardian Name #2 (who resides with child)
Your answer
Address (Include City, State & Zip Code
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Your answer
Mailing Address (if different from above)
Your answer
Phone Number
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Your answer
Person(s) other than parents, authorized to drop off and pick up child(ren)
Your answer
Emergency Contact (Not Parent or Guardian) and phone number
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Your answer
Faith Community Church has my permission to use photos of my child/children in publications, video, or on their website.
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Yes
No
As the parent or legal guardian of the minors listed below, I agree to release Faith Community Church from any and all claims losses, damages and liabilities to any and all property damage, personal injury and/or death arising from participation in scheduled activities.
In case my child is in need of medical or surgical treatment, to protect their health and welfare while participating, I authorize and agree to allow any authorized agent or employee of Faith Community Church to consent to and authorize and administering of necessary medical treatment. I understand that said treatment shall be pursued only after a reasonable effort has been made to reach parents/guardians or the emergency contacts on this form.
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No
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Student Name
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Your answer
Age
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Your answer
Birth Date
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YYYY
Grade Entering
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Your answer
Allergies or Special Instructions
Your answer
Student Name
Your answer
Age
Your answer
Birth Date
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DD
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YYYY
Grade
Your answer
Allergies or Special Instructions
Your answer
Student Name
Your answer
Age
Your answer
Birth Date
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DD
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YYYY
Grade
Your answer
Allergies or Special Instructions
Your answer
Student Name
Your answer
Age
Your answer
Birth Date
MM
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DD
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YYYY
Grade
Your answer
Allergies or Special Instructions
Your answer
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