Yearly Registration '23-'24 School Year

starts Sept. 10th | Please fill out one per child. This is a medical release for Sunday School, Midweek events, special events, or other times your child will be with FPC Staff or Volunteers.

Child Information

Child's Name

Grade

Please select one option.

2 and under Pre-Kindergarten Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Graduated

Date of Birth

Parent/Guardian Information

Parent/Guardian 1

Parent/Guardian 2

This address will receive a confirmation email

Phone

Address

Emergency Information

Doctor's Name

Doctor's Phone

Emergency Contact's Name

Emergency Contact's Phone

Emergency Contact's Address

Hospital Preference

Health Information

Please List any Special Medical Conditions:

Allergies we need to be aware of (such as food or bee stings):

Last Tetnus Shot (DTaP for younger children):

Other

I consent to allow FPCSS to take and use pictures or videos of my child. These photos may be posted on the website or newsletter as a recap of the event or for promotion of future events. These photos may also be posted on the FPC social media accounts to share what's going on in the life of our church. No names will be used.

Photos

Please select all that apply.

Photos NO Photos

Comments:

Description

starts Sept. 10th

Please fill out one per child. This is a medical release for Sunday School, Midweek events, special events, or other times your child will be with FPC Staff or Volunteers.

Yearly Registration '23-'24 School Year

Description

Please Fix the Following