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Please complete a registration form for each participating child.

Child's First Name*:

Child's Last Name*:

Birthdate*:            Grade*:                    Gender:

Parent(s)/Guardian(s)*:

Street Address*:

City*:       State*:             Zip code*:

Home Phone*:             Cell Phone*:

E-mail address:

Home Church (if any):

Emergency Contact:

Name(s):

Home Phone:                Cell Phone:

Please indicate below anything else that you would like the staff to know (e.g., allergies)


NSCBC periodically takes pictures and video of the  ministries to use in presentation and promotional materials. Please indicate if you give the church permission to use your child's picture for these purposes. 
 

Please list below individuals you authorize to pick up your child from Friday Footsteps.

Name:     Phone:

Name:     Phone:

Name:     Phone:

Items marked with an asterisk "*" are required.