Child/Youth General Registration

Please have your CareCard and Doctor's name and number handy before starting this form. After you have filled out this form, register your child for their individual programs.

Child/Youth Information

Name

*

Gender

*

Please select one option.

Male Female

Home Phone

Mobile Phone

Email

This address will receive a confirmation email

Birthdate (eg. 01/31/2010)

*

Grade

*

Please select one option.

Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12

Allergies

*

Please select one option.

Yes No

Explain Allergies

Disabilities

*

Please select one option.

Yes No

Explain Disabilities

Doctor

*

Doctor Phone

*

CareCard Number

*

Parent/Guardian Information

Parent/Guardian 1

*

Relationship to Child/Youth

*

Please select one option.

Mother Father Grand-Mother Grand-Father Aunt Uncle Guardian Other

Parent 1 Home Phone

Parent 1 Mobile

Parent 1 Work Phone

Parent 1 Email

*

Address

*

Additional parent/guardian (please fill in, if there is a second parent/guardian)

Parent/Guardian 2

Relationship

Please select one option.

Mother Father Grand-Mother Grand-Father Aunt Uncle Guardian Other

Parent 2 Home Phone

Parent 2 Mobile

Parent 2 Work Phone

Parent 2 Email

Parent 2 Address (if different)

Emergency Contact

Name (other than parent or guardian)

*

Relationship

*

Please select one option.

Aunt Uncle Grandparent Family friend Other

Emerg. Contact Phone

*

Do you want your family in the church directory?

Church Directory

*

Please select all that apply.

Yes No

Please note that once this form is complete you will still need to sign your child/youth up for their specific FBC program. But that form is super quick!

Description

Please have your CareCard and Doctor's name and number handy before starting this form. After you have filled out this form, register your child for their individual programs.

Please Fix the Following

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