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9037 State Route 132 West
Clay, KY 42404
270-664-2414
Your Custom Text Here
About Us
About Us
Leadership
Beliefs
Service Times
Connect
What to Expect
New Visitors
Our Approach to Discipleship
Church Membership
Member Care Info
What is the Gospel?
Ministries
Every Member In Ministry
Children
Teens
Adults
Small Groups
Griefshare
Marsha's Place PRC
Resources
Sunday Bulletins and Outlines
Sermons
Sermon Response Form
Give
Contact Us
FBC Clay Wednesday Ministry Registration
Form must be completed before the next week’s Wednesday Ministry
Parent/Guardian 1
*
First Name
Last Name
Relationship to Child
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
This is the address where my child(ren) will be picked up and dropped off
If applicable
Yes
Parent/Guardian 2
*
First Name
Last Name
Relationship to Child
*
Phone
*
(###)
###
####
Address if different from primary address of children
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
This is the address where my child(ren) will be picked up and dropped off
If applicable
Yes
Emergency Contact (other than guardians)
*
First Name
Last Name
Relationship to Child
*
Phone Number
*
(###)
###
####
Adults authorized to pick up child(ren)
First Name
Last Name
Adults authorized to pick up child(ren)
First Name
Last Name
Individual Children Information
Child #1
*
Name/Age/Birthdate/Gender/Grade/Allergies and/or Special Needs
Child #2
Name/Age/Birthdate/Gender/Grade/Allergies and/or Special Needs
Child #3
Name/Age/Birthdate/Gender/Grade/Allergies and/or Special Needs
Child #4
Name/Age/Birthdate/Gender/Grade/Allergies and/or Special Needs
Child #5
Name/Age/Birthdate/Gender/Grade/Allergies and/or Special Needs
*By registering my child(ren) for FBC Clay Children’s Ministry I authorize that my child’s image may be photographed, filmed, and used in video, print and web presentations. *By giving my email address, I understand that I will be added to FBC Clay Children’s Ministry mailing list. FBC Clay will not give your personal information to any third parties. *I give my permission for my child to participate fully in FBC Clay Children’s Ministry including snacks, games, transportation, and will not hold FBC Clay responsible for any accidents that might occur. In case of emergency, I understand that every effort will be made to contact the guardians of the child(ren). In the event that I cannot be reached, I hereby give permission for the medical personnel selected by the church staff to secure proper and necessary treatment for my children.
*
Yes
Thank you!