FCC Event Student/Child Registration Form Please use this form to register your child(s) for events at FCC. Name - Parent #1(Required) First Last Preferred Email - Parent #1(Required)Cell - Parent #1(Required)Name - Parent #2 First Last Preferred Email - Parent #2 Cell - Parent #2Your Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Name - Child #1(Required) First Last Date of Birth - Child #1(Required) MM slash DD slash YYYY Child's Grade Level - Child #1(Required) Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Programs Interested - Child #1 Sunday School Vacation Bible School Faith Explorers (4th - 5th Grade) Junior Fellowship (6th - 8th Grade) Pilgrim Fellowship (9th - 12th Grade) Confirmation Our Whole Lives Family Music (Birth - 6) Melody Makers (K - 2) Carol/Chancel Choir (3 - 8) Youth Bell Choir (3 - 8) Alleluia Sound (9 - 12) Good Vibrations Bell Choir (9 - 12) Special Needs or Allergies - Child #1Do you want to add another child? Yes Name - Child #2 First Last Date of Birth - Child #2 MM slash DD slash YYYY Child's Grade Level - Child #2 Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Program Interest - Child #2 Sunday School Vacation Bible School Faith Explorers (4th - 5th Grade) Junior Fellowship (6th - 8th Grade) Pilgrim Fellowship (9th - 12th Grade) Confirmation Our Whole Lives Family Music (Birth - 6) Melody Makers (K - 2) Carol/Chancel Choir (3 - 8) Youth Bell Choir (3 - 8) Alleluia Sound (9 - 12) Good Vibrations Bell Choir (9 - 12) Special Needs or Allergies-Child #2Do you want to add child #3 Yes Name - Child #3 First Last Date of Birth -Child #3 MM slash DD slash YYYY Child's Grade Level-Child #3 Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Program Interest - Child #3 Sunday School Vacation Bible School Faith Explorers (4th - 5th Grade) Junior Fellowship (6th - 8th Grade) Pilgrim Fellowship (9th - 12th Grade) Confirmation Our Whole Lives Family Music (Birth - 6) Melody Makers (K - 2) Carol/Chancel Choir (3 - 8) Youth Bell Choir (3 - 8) Alleluia Sound (9 - 12) Good Vibrations Bell Choir (9 - 12) Special Needs or Allergies - Child #3Do you want to add child #4 Yes Name - Child #4 First Last Date of Birth -Child #4 MM slash DD slash YYYY Child's Grade Level -Child #4 Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Program Interest -Child #4 Sunday School Vacation Bible School Faith Explorers (4th - 5th Grade) Junior Fellowship (6th - 8th Grade) Pilgrim Fellowship (9th - 12th Grade) Confirmation Our Whole Lives Family Music (Birth - 6) Melody Makers (K - 2) Carol/Chancel Choir (3 - 8) Youth Bell Choir (3 - 8) Alleluia Sound (9 - 12) Good Vibrations Bell Choir (9 - 12) Special Needs or Allergies -Child #4EMERGENCY CONTACT/RELEASESEmergency Contact Name and Cell(Required)PHOTO RELEASE: Do you agree to allow photos of your child to be used in church presentations or church promotional materials?(Required) Yes No MEDICAL TREATMENT: As a parent and/or guardian, of the minor(s) listed on this form, I do herewith authorize the treatment by a qualified and licensed medical physician in the event of an emergency which, in the opinion of the attending physician, may endanger the minor's life, cause disfigurement, physical impariment or undue discomfort if delayed. This authority is granted only after reasonable effort has been made to reach me. I release First Congregational Church, their employees, and volunteers from any claim of liability in connection therewith.(Required) Yes No PARTICIPATION AUTHORIZATION: I grant permission for the minor(s) listed on this form to attend on-site & off-site events and activities of the First Congregational Church program in which he/she is enrolled. I will be notified in advance of such activities.(Required) Yes No Anything Else You Think We Should Know?Parent #1(Required)Parent #2Section BreakSection BreakSection BreakUntitled
