Registration Form

Fairview Kids & Awana

I am registering for the following program(s): *
Child's Name *
Child's Name
Gender *
Date of Birth *
Date of Birth
Current Grade *
as of September 2016
Home Address *
Home Address
Home Phone *
Home Phone
Cell Phone
Cell Phone
(optional)
Mother's Name *
Mother's Name
(or primary female caregiver)
Father's Name *
Father's Name
(or primary male caregiver)
Who has custody? *
Does your child have any allergies or medical concerns? *
*For saftey purposes, you will also be asked to fill out a Medical Alert Form
Emergency Contact *
Emergency Contact
Other than Mother or Father
Emergency Contact Phone *
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.
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.
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.
(Optional)
Participation
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, ITS PASTORS AND ELDERS FROM AND AGAINST ANY LOSS, DAMAGE 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 AND AUTHORIZATION IS ONLY EFFECTIVE WHEN PARTICIPATING IN OR TRAVELING TO EVENTS SPONSORED BY FAIRVIEW BAPTIST CHURCH. *
Information
FAIRVIEW BAPTIST CHURCH IS COLLECTING AND RETAINING THIS PERSONAL INFORMATION FOR THE PURPOSE OF ENROLLING YOUR CHILD IN OUR PROGRAMS, TO ASSIGN THE CHILD TO THE APPROPRIATE CLASSES, TO DEVELOP AND NURTURE ONGOING RELATIONSHIPS WITH YOUR CHILD, AND TO INFORM YOU OF PROGRAM UPDATES AND UPCOMING OPPORTUNITIES AT OUR CHURCH. 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. *