Family Registration Form

dz family registration form

New to Fellowship? Save yourself some time on your first visit by filling out this form ahead of time!

Family Last Name *

Mom's Name *

First

Last

Mom's Cell *

Dad's Name *

First

Last

Dad's Cell *

Address *

City *

Zip Code *

Cell Service Provider *

Other (If Applicable) *

Email *

Child 1 Name *

Birthday *

Grade *

Allergies (If Any) *

Child 2 Name *

Birthday *

Grade *

Allergies (If Any) *

Child 3 Name *

Birthday *

Grade *

Allergies (If Any) *

Child 4 Name *

Birthday *

Grade *

Allergies (If Any) *

Other Adults Allowed to Pick up my Kids *

Emergency Contact Name *

First

Last

Phone Number *

relationship to kids *

I would like to receive information on upcoming events.

Select One *

I give my consent to change my child's diapers or assist if they have a bathroom accident.

Select One *

Yes No

I give my consent to Fellowship Chapel to take photos and videos of my child while participating in activities with the church. I understand these images may be posted in the building and/or on our church web site.

Select One *

Yes No

We will be contacting you by text if there is a problem with one of your children that requires your attention.
Please be attentive to your cell phone and keep it on vibrate.

Submit

dz family registration form

hours

address