New Kid Registration • Friends Baptist Church

Child's First Name *

Child's Last Name *

Gender

Date of Birth

Email Address

Allergies

Yes

Home Address

Home City

Home State

Home Zip Code

Special Needs Child

Special Restrictions

Tip: Are there any special restrictions for your child that you would like us to know?

Please include the name of the parent that has primary permission to pickup your child.

Parent's Last Name *

Parent's First Name *

Mobile Number *