Preschool, Children, and Special Needs Registration

Enrollment and Permission for FBG Preschool, Children, and Special Needs Activities

2023-2024

This is a general enrollment and permission valid from August 2023-August 2024 for your child/children’s participation in Sunday morning, Wednesday night and other specified activities. Some activities during the year may require additional registration, payment or specific waivers.

Please contact Bridget Kokolis with questions.

"*" indicates required fields

Contact Information

Parent/Guardian 1 Name*

Parent/Guardian 1 Email*

Parent/Guardian 1 Cell Number*

Parent/Guardian 1 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Cell Number

Emergency Contact Name*

Emergency Contact Phone*

Permission and Photo/Video Release

Click to download and read waiver.

I agree with the waiver.*

Please check one.

Yes

Please contact me to discuss

Signature

Sign with Mouse, trackpad, or on a touchscreen device.

Information About Your Child

Please complete this information for every child 5th grade or younger or in the St. Francis class.

Child's Name*

First Last

Child's Birthdate*

Child's age group at church

Child's School

if applicable

Please list any food Allergies.

Please list any medications.

Is child 1st Grade or Older?*

Yes

For Children 1st Grade and older- medical information

Knows how to swim

Yes

Date of last Tetanus Shot

Name of Medical Insurance Company

Policy Number

Child's Physician's Name

Child's Physician's Phone Number