Register

Instructions: Fill out this form and press the "Submit" button to send the completed form to the church. Or, if you wish, print and mail a PDF version of the same form (available here) to our address, drop it off at the church office at any time, or drop it off at the registration table on the first day of VBS. Thanks!

Name of Parent/Guardian:

Address:

Phone #:

Cell #:

Email:

Family Doctor:

Doctor Phone #:

Emergency Contact:

Phone #:

Alternate Emergency Contact:

Phone #:

Children to be Enrolled

	Name	Age	Grade in School 9/10
1.
2.
3.
4.

Food Allergies:

Medical Conditions:

Member of a Church? Yes No
If yes, name of church:

Are children baptized? Yes No

Do you need transportation? Yes No

Can you furnish transportation for other children in your neighborhood? Yes No

Permission to post child's photo on a secure portion of the FLC website? Yes No

Please note: A parent/guardian signature will be required when you arrive at Faith on the first day of the Summer Kids Konnection.

Register

Children to be Enrolled

Name

Age

Grade in School 9/10