4210 Limestone Road Wilmington, Delaware 19808
(302) 998-4105
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2020-2021 Child/Youth Registration
Expires on June 30, 2021
1
Parent / Guardian
2
Children
3
Emergency Contact
4
Authorization
Parent/Guardian #1 Information
Parent/Guardian #1 - Name
*
First
Last
Parent/Guardian #1 - Relationship to the Child(ren)
Parent/Guardian #1 - Cell Phone
*
Parent/Guardian #1 - Email
*
Parent/Guardian #1 - Church You Attend (if applicable)
Parent/Guardian #2 Information
Parent/Guardian #2 - Name
First
Last
Parent/Guardian #2 - Relationship to the Child(ren)
Parent/Guardian #2 - Cell Phone
Parent/Guardian #2 - Email
Parent/Guardian #2 - Church You Attend (if applicable)
Home Information
Address where the child(ren) resides
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Other than a Parent/Guardian, who will be transporting the child(ren)?
Name
Phone Number
Legal Release
I (we), by signing this release, do hereby agree to the following: In the event of an accident or injury occurring on the premises of Faith Baptist Church, to myself (ourselves) and/or anyone else under my (our) care, control, or custody, do hereby agree to hold Faith Baptist Church and its insurance company free and harmless and to present no claim for damages against Faith Baptist Church or its insurance company.
Name of the Adult Authorizing the Legal Release and Approve of Emergence Medical Treatment if needed for the child(ren)
*
First
Last
How many children are you registering?
1
2
3
4
5
What are you registering for?
*
Sunday Morning Child/Youth Ministries
Wednesday Youth Group
Vacation Bible School
Easter Egg Hunt
Summer Camp
Man Hunt (Youth Group)
Youth Volunteer
Check all that apply. This form is good for activities your child(ren) will attend before June 30, 2021.
Are you authorized to approve medical care for this child?
*
Yes
Child #1
Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Month
1
2
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5
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12
Day
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Year
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2021
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
School Grade for the 2020-2021 school year
*
Nursery
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Medical Information
Please list any allergies, disabilities, or other medical conditions we should be aware of. Include symptoms, medications, and restrictions.
What medications, with instructions, do you want us to hold for your child?
Medication Permission
Yes
No
If applicable based on your instructions above, do we have your permission to provide medications if needed?
Travel Permission
Yes
No
I give permission for my child/children to travel with the church to offsite events.
Photo Permission
*
Yes
No
I give my permission for my child’s picture or digital image to be used for church promotional purposes. If your answer is “no”, your child may not be allowed to be part of presentations such as a church worship service.
Child #2
Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
School Grade for the 2020-2021 school year
*
Nursery
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
School Grade for the 2020-2021 school year
*
Nursery
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Medical Information
Please list any allergies, disabilities, or other medical conditions we should be aware of. Include symptoms, medications, and restrictions.
What medications, with instructions, do you want us to hold for your child?
Medication Permission
Yes
No
If applicable based on your instructions above, do we have your permission to provide medications if needed?
Travel Permission
Yes
No
I give permission for my child/children to travel with the church to offsite events.
Photo Permission
*
Yes
No
I give my permission for my child’s picture or digital image to be used for church promotional purposes. If your answer is “no”, your child may not be allowed to be part of presentations such as a church worship service.
Child #3
Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
School Grade for the 2020-2021 school year
*
Nursery
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Medical Information
Please list any allergies, disabilities, or other medical conditions we should be aware of. Include symptoms, medications, and restrictions.
What medications, with instructions, do you want us to hold for your child?
Medication Permission
Yes
No
If applicable based on your instructions above, do we have your permission to provide medications if needed?
Travel Permission
Yes
No
I give permission for my child/children to travel with the church to offsite events.
Photo Permission
*
Yes
No
I give my permission for my child’s picture or digital image to be used for church promotional purposes. If your answer is “no”, your child may not be allowed to be part of presentations such as a church worship service.
Child #4
Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
School Grade for the 2020-2021 school year
*
Nursery
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Medical Information
Please list any allergies, disabilities, or other medical conditions we should be aware of. Include symptoms, medications, and restrictions.
What medications, with instructions, do you want us to hold for your child?
Medication Permission
Yes
No
If applicable based on your instructions above, do we have your permission to provide medications if needed?
Travel Permission
Yes
No
I give permission for my child/children to travel with the church to offsite events.
Photo Permission
*
Yes
No
I give my permission for my child’s picture or digital image to be used for church promotional purposes. If your answer is “no”, your child may not be allowed to be part of presentations such as a church worship service.
Child #5
Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
School Grade for the 2020-2021 school year
*
Nursery
Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Medical Information
Please list any allergies, disabilities, or other medical conditions we should be aware of. Include symptoms, medications, and restrictions.
What medications, with instructions, do you want us to hold for your child?
Medication Permission
Yes
No
If applicable based on your instructions above, do we have your permission to provide medications if needed?
Travel Permission
Yes
No
I give permission for my child/children to travel with the church to offsite events.
Photo Permission
*
Yes
No
I give my permission for my child’s picture or digital image to be used for church promotional purposes. If your answer is “no”, your child may not be allowed to be part of presentations such as a church worship service.
Extra Adult Emergency Contact
In case of emergency, accident or illness, reasonable efforts will be made to contact the parent/guardian. Please provide the emergency contact of a relative or friend to contact if you cannot be reached. Please advise them that you have put their name on this form. Please advise us of any changes throughout the year.
Name
*
First
Last
Relationship to the child(ren)
*
Cell Phone
*
Home Phone
Authorized Sign-Outs
Please list the names, relationships & phone numbers of the ADULTS (age 18 or older) authorized to sign your children (age 12 and under) out of FBC ministries. Any changes in sign out authorization need to be made at the time, or before, your child is dropped off.
Name
Relationship to the child(ren)
Phone Number
Name
Relationship to the child(ren)
Phone Number
Name
Relationship to the child(ren)
Phone Number
Name
Relationship to the child(ren)
Phone Number
Authorization
I have the authority to grant permission and agree to the conditions of this registration form.
Your Name
First
Last
https://vimeo.com/397282891
New here?
Visit Us
Hispano
Services and Activities
What to Expect
Experience Hope
Information For Parents
About Us
Meet Our Pastors
Our Beliefs
Vision Statement
History
Get Involved
Children
Preschool
Cubbies
Faith Kids
Youth/Student
Young Adults
Adults
Adults Life Groups
Men
Women
Sr. Adults
Sunday School
Hispanic Ministries
Missions
Music & Worship
Resources
Sermons
Bulletins
Memorial Services
Membership Application
Child/Youth Registration
Permission Slips
Who to Contact?
Hispano
Hispano
¿Qué Esperar?
Horario de Servicio
Información para Padres
Calendar
Give
Contact
Contact Us
Meet Our Pastors
4210 Limestone Road Wilmington, Delaware 19808
(302) 998-4105