Name: Adult Discipleship
Start: 2019-12-11T18:00:00-05:00
End: 2019-12-11T19:00:00-05:00
Location: Fellowship Hall

Parent/Guardian Name*
First Last
Child's Name*
First Last
Enter one child's name here. If there are additional children, please fill out a separate form.
Wednesday Night Choices*
- Children's Choir only
- Mission Kids only
- Both Children's Choir and Mission Kids
Please select the appropriate box whether your child will participate in Children's Choir, Mission Kids, or both.
Child's Gender*
- Male
- Female
Child's Grade*
What grade will your child be in during the 2019-2020 School Year?
Child's age*
Please enter a number from 3 to 12.
Please indicate your child's age
Birthdate*
Date Format: MM slash DD slash YYYY

What is your child's birthdate?
Allergies or Medical Conditions*
Please describe any allergies or medical conditions we need to be aware of below or write 'none' in the blank field.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mother's Email*
Father's Email*
Mother's cell phone*
Please list the number where we can reach you during Wednesday Night Activities
Father's cell phone*
Please list the number where we can reach you during Wednesday Night Activities
Photographic consent*
- Yes
- No
Please indicate whether or not you authorize First Baptist Church to publish photographs taken during the program year. I understand that my child's full name will not be named in any publications.

Children’s Ministry Registration Fall 2019

Wednesday Night Dinner