Preschool, Children, and Special Needs Registration

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

2022-2023

This is a general enrollment and permission valid from August 2022-August 2023 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 Becky Ramsey, Amy Joye, or Sarah Ramsey-Smith 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