JAM 2022-2023 Participant Registration

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FBCM Elementary School (K-5th Grades) Wednesday Night Program

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Parent/Guardian 1 Name *

Parent/Guardian 2 Name

Address *

Email *

Best Emergency Contact Phone Number *

Secondary Contact Phone Number *

I would like to be added to the FBCM Children's Ministry Facebook Group *

Yes

I am already a part of this group.

I would like to receive FBCM Children's Ministry Remind text alerts *

Yes

I already receive them

The best way to contact/communicate with me is... *

Text and/or Remind

Phone Call

Facebook

Child 1 First & Last Name *

Child 1 DOB *

ÅÅÅÅ

Child 1 School Grade *

Child 1 Allergies?

Child 2 First & Last Name

Child 2 DOB

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Child 2 School Grade

Child 2 Allergies?

Child 3 First & Last Name

Child 3 DOB

ÅÅÅÅ

Child 3 School Grade

Child 3 Allergies?

Child 4 First and Last Name

Child 4 DOB

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Child 4 School Grade

Child 4 Allergies?

If you have more than 4 children, please put the NAME, DOB, School GRADE, and any ALLERGIES of each of the remaining children in this box.

I understand that any Child(ren) I drop off are to be picked up each night by 7:35 *

Yes

Obligatorisk

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