Children Sunday Registration

Parent or Guardian's Name *

First Name

Last Name

Cell Number *

(###)

###

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Second Parent or Guardian's Name

First Name

Last Name

Cell Number

(###)

###

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child 1 *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Child 2

First Name

Last Name

Birthdate

MM

DD

YYYY

Child 3

First Name

Last Name

Birthdate

MM

DD

YYYY

Child 4

First Name

Last Name

Birthdate

MM

DD

YYYY

Emergency Medical Release and Risk *

Should it be necessary for my child to have medical treatment while participating in the church activity, I give the adult in charge permission on my behalf to secure hospitalization or medical services deemed necessary by the physician. I absolve said church and its personnel from any and all forms of negligence and wrong treatment incurred in the procurement and process of hospitalization and medical treatment. I understand that FCBC Walnut has no medical insurance and any medical costs shall be my sole responsibility. With regards to all indoor or outdoor activities, injuries may occur and other risks must be considered, including the risk of contracting Covid-19 or any other common respiratory or gastrointestinal infection.

I agree

Photo Release *

I hereby give permission for photographs of my child to be used for church promotions in print and/or on the internet.

I agree

Parent Agreement *

For your child's safety, parent(s) must attend the worship service, Sunday School or small group while their Nursery or Preschool child is in class. Parents must not drop off their child and then leave the church premises or loiter on the church premises.

I acknowledge that this church is not a licensed childcare facility.