Registration for Junior Youth Group (2017-2018)

Student Name *
Student Name
School Grade *
(As of September 2017)
Gender *
Date of Birth *
Date of Birth
Address *
Home Phone *
Home Phone
Mother's Name *
Mother's Name
Mother's Cell Phone
Mother's Cell Phone
Father's Name *
Father's Name
Father's Cell Phone
Father's Cell Phone
Youth's Cell Phone
Youth's Cell Phone
In Case of Emergency, contact: *
In Case of Emergency, contact:
Emergency Contact Phone *
Emergency Contact Phone
Allergies or Medical Concerns? *
(You will also be asked to fill out a Medical Alert Form)
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 travelling to events sponsored by Fairview Baptist Church.
Purpose and Extent
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 ur 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.
Photo Permission
Do you give permission for photos of your son/daughter to be used in the following locations? *
Click all that are permitted