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FBCC KIDS & Student Ministries
Connection Form
Please Register for our Church Records
Child's First Name
Child's Last Name
Parent/Guardian Name
Parent/Guardian's Email
Parent/Guardian's Phone
Child's Date of Birth
What level of education is your child currently in?
Infant/Toddler
Preschool
Elementary
Middle School
Junior High School
High School
Does your child have any known allergies including food or environmental? Or any other medical conditions that we need to be aware of?
Has anyone in the household tested positive for Covid-19 in the past 14 days?
Have you had any contact with a COVID positive person in the last 14 days?
Has the student or anyone in the household had any new symptoms
Fever or chills
Headache
Cough, sore throat, runny nose, congestion
Loss of taste or smell
Shortness of breath or difficulty breathing
Nausea, vomiting, or diarrhea
Fatigue or muscle/body aches
None of the above
(FBCC Kids) When our teachers offer a snack, can your child have Pepperidge Farms Goldfish?
Yes
No
Not Applicable
Please provide any more information that we can support you as a parent with your child?
I agree to the terms & conditions I, the parent or legal guardian of the participants, acknowledge that participation in FBCC Kids and/or FBCC Glory Bound Youth Ministries may involve the risk of exposure of other minor's illness or risk of injury during physical activities. I further acknowledge that these ministries is primarily administered by screened & background checked volunteers of FBCC. I hereby release, the Church staff, its volunteered workers, sponsoring organizations, and other representatives from any claims arising out of or related to any physical injury or unknown exposed illness that may occur to the said individuals while participating in this ministry.
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