First Baptist Church - Pompano - Team KID Registration Form

1). Child's First Name

Last Name

Gender
Male
Female

Birthdate

Grade

Food Allergies

Important: Please check if YES
My child attends FBC Preschool Learning Center
My child attends FBC Day Camp

2). Child's First Name

Last Name

Gender
Male
Female

Birthdate

Grade

Food Allergies

Important: Please check, if YES
My child attends FBC Preschool Learning Center
My child attends FBC Day Camp

3). Child's First Name

Last Name

Gender
Male
Female

Birthdate

Grade

Food Allergies

Important: Please check if YES
My child attends FBC Preschool Learning Center
My child attends FBC Day Camp

Should we be aware of any health, emotional, or developmental concerns regarding your child/children?
Yes
No

If yes, please list:

Parent/Guardian First Name

Parent/Guardian Last Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Home/Cell Phone Number

Parent/Guardian Email

Parent/Guardian Marital Status

The child/children live with:
Both Parents
Mother
Father
Other

Emergency Contact

First Name

Last Name

Phone Number

Are you a church member?
If yes, which church?

Parent/Guardian Agreement
I give my child permission to participate in the Team KID program on Wednesday nights at First Baptist Church Pompano Beach from 6:00-7:30 pm.
I know my child must bring and wear a mask during Team KID.
I also agree to follow the Team KID safety dress code: Team KID T-shirt and close-toed shoes.
I'd like information regarding volunteering @ Team KID.

FBC May publish any photographs or video of my child during this program.
Yes
No

Parent/Guardian Signature

Registering how many children?
1 Child - $40.00
2 Children - $75.00
3 Children - $110.00
4 Children - $145.00

Stripe Credit Card Number

Expiration Date

CVV

Name on Card

First Name

Last Name

We're excited to have your children with us!

Fill out the form below to get started.