Gender
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Select Option
Male
Female
Current Grade as of May 2026 (Grade completed, not grade entering)
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Select Option
3 years old by July 19 and potty trained
4 years old and not attending Kindergarten in the fall
5 years old or attending Kindergarten this fall
Kindergarten completed
1st grade completed
2nd grade completed
3rd grade completed
4th grade completed
5th grade completed
6th grade completed
Food Allergies: (Please note with gluten or dye free allergies, we ask that you provide an alternate snack for your child to bring with them. Julie will email you what we plan to have each day to see what is okay for your child to have or not)
Conditions / Special Needs: (Other Medical or Behavioral Conditions)? [Ex: Asthma, ADHD, Autistim, etc.]
Additional Notes: Is there anything additional that we should know about your child?
PARENT/GUARDIAN INFORMATION
EMERGENCY CONTACT INFORMATION
Please provide an emergency contact for your child if we cannot reach you or a second parent/guardian as stated above.
Photo / Video Consent: I authorize the use of video and/or images of the above child/minor for social media posts and/or other visual material of First Church.
Photo / Video Consent
*
Select Option
Yes
No
Permission Acknowledgement: I give permission for the above child/minor to attend and to be transported to and from First Church gatherings and events.
Permission Acknowledgement
*
Select Option
Yes
No
Release Acknowledgement: It is our great pleasure to serve our community and to have your child/minor participate in our gatherings and events! We do make effort to provide safe and appropriate environments, as well as safe and responsible drivers to provide transportation. That said, we all understand that accidents do happen and unforeseen incidents do occur. Thus, it is our reminder to you that your signature will completely and unconditionally indemnify, hold harmless, and release First Church and its agents, employees, volunteers, and persons from any and all liability cause by negligence of First Church and said persons or behaviors of child/minor for personal injuries, property damage, or wrongful death, in the participation and/or transportation to and/or from First Church and its related events.
Electronic Signature: I consent to the signing of this release form by an electronic signature.
