Fairview Juniors 2023-2024 Grade 4 to Grade 6 Registration

Child's Name

Birthdate

Grade as of Sept. 2023

Gender

Male Female

This address will receive a confirmation email

Home Phone

Cell Phone

Address

Mother's Name

Father's Name

Who has custody?

Both Parents Together Mother Father Other

If "other", please specify:

Any Medical Concerns?

Yes No

If "yes", please specify:

Emergency Contact (Other than Parents)

Emergency Contact Phone

Photo Waiver

I give permission for photos of my child to be taken for Fairview Kids activities and for use within our church presentations and website.

Yes No

Drop Off/Pick Up Authorization

As parent/guardian, I hereby authorize the following persons to drop off/pick up my child from Fairview Baptist Church. I hereby agree to inform the following persons that proper identification may be required in order to drop off/pick up my child.

Name

Phone

Relationship to Child

Name

Phone

Relationship to Child

Participation Form

The safety of your child is our primary concern. Precautions will be taken for their well-being and protection. Do you agree to indemnify and hold harmless ministry personnel, Fairview Baptist Church, it’s Pastors and leaders from and against any loss, damage, sickness or injury suffered by your child as a result of being part of the activities of Fairview Baptist Church, as well as of any medical treatment authorized by supervising individuals representing the church? This consent is only effective when participating in or traveling to events by Fairview Baptist Church.

Yes, I/we have read, understood and agree with the above.

Information Waiver

Fairview Baptist Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with your child, and to inform you of program updates and upcoming opportunities at Fairview. This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel. If you wish Fairview Baptist Church to limit the information collected, or to view your child’s information, please contact us.

Yes. I/we have read, understood and agree with the above.

Fairview Juniors 2023-2024 Grade 4 to Grade 6 Registration

Description

Please Fix the Following