Kidz Club Registration

Child's Name

Grade

Age

Please enter Birthdate DD-MM-YYYY

Birthdate

Allergies?

Any extra information that would be important for us to know about your child to assist us in teaching them effectively?

Parent/Guardian Information

Parent/Guardian Name

Primary Phone

Secondary Phone

This address will receive a confirmation email

Address

Medical Release Statement

Precautions are taken for the safety and health of your child, but in the event of an accident or sickness, FBC, its staff, and its volunteers are hereby released from any liability. In the event that your child requires special medication, x-rays or treatment, the parents/guardians will be notified immediately.

I Agree I Disagree

FOIP Agreement

In accordance with our Plan to Protect policy, Fellowship Baptist Church requires parental consent for the release of your child’s photograph, video clips or comments in activities that she/he may participate in through church programs. In Fellowship Kids, Christmas or other pageant are examples of where this publication may occur. I give my consent for the publication of my child’s photograph, video clips of comments for purposes consistent with the above.

I agree I Disagree

FBC Contact Agreement

I give Fellowship Baptist Church permission to contact me in regards to upcoming events at FBC Drumheller.

I Agree I Disagree

Payment 36 CAD

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Kidz Club Registration

Description

Please Fix the Following