Preschool, Children, and Special Needs Registration

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

2021-2022

This is a general enrollment and permission valid from August 2021-August 2022 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 Laura Stout, Becky Ramsey, Juli Morrow, Amy Joye, or Sarah Ramsey-Smith with questions.

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*
MM slash DD slash YYYY
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
- No
For Children 1st Grade and older- medical information
Knows how to swim
- Yes
- No
Date of last Tetanus Shot
MM slash DD slash YYYY
Name of Medical Insurance Company
Policy Number
Child's Physician's Name
Child's Physician's Phone Number

Preschool, Children, and Special Needs Registration

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

2021-2022

Contact Information

Permission and Photo/Video Release

Information About Your Child

For Children 1st Grade and older- medical information

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