Wufoo

Youth Registration

For registering students for Middle School, High School, and College Programs

Program *
Middle School Ministries High School Ministries College Ministries

Please select which program the student is being registered for at this time
Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Number * ### - ### - ####
Student Cell Phone Number ### - ### - ####
Student's Email
Gender *
Male Female
Birthdate * MM / DD / YYYY
Current Grade *
Maximum Allowed: 13 digits. Currently Used: 0 digits.

Please enter the current number grade of the student. (Ex: 0 = Kindergarten, 1 = First Grade, ect.)
Graduation Year *
Must be between 4 and 4 digits. Currently Used: 0 digits.

Please enter the graduation year of the student based on current grade progression.
Current Allergies | Medications | Special Physical/Emotional/Cognitive Needs
Parent | Guardian Information
Name of Mother | Guardian 1 * First Last
Cell Phone Number ### - ### - ####
Email
Name of Father | Guardian 2 First Last
Cell Phone Number ### - ### - ####
Email
Emergency Contact Information

Please provide contact information for two adults other than the parent or guardian.
Name of Emergency Contact * First Last
Phone Number * ### - ### - ####
Relationship to the Child *
Name of Emergency Contact 2 * First Last
Phone Number * ### - ### - ####
Relationship to the Child *
Liability Release

As the parent or legal guardian of the child listed above, I understand that all activities have the inherent possibility of injury to person or property, and may result from participating in activities which include strenuous activities, volleyball, basketball, hiking, and/or other related sports and that we play and allow. Injury and property damage may also result from activities which we do not allow and may result from participation in activities which are prohibited. I understand that this release constitutes a full and complete release from liability insofar as Felton Bible Church is concerned, and by signing below, I hereby hold harmless the management and trustees of Felton Bible Church and the Felton Bible Church staff and volunteers, of responsibility for any and all injury or damage to person or property.
Parent or Legal Guardian's Signature *

Type your name here to indicate that you have read, understand, and agree to the above liability release for Felton Bible Church.
Do Not Fill This Out

Wufoo

Youth Registration

Parent | Guardian Information

Emergency Contact Information

Liability Release