Registration: Children and Youth Ministries
Register here for Sunday night programs for children and youth, including the Neighborhood Youth Project. More than one child in different age groups? You only need to complete this form once for your family.

If you have questions or need more information, please reach out.
Children's programs: Lee Hull Moses, pastor@fccgreensboro.org
Youth programs: Melissa Guthrie Loy, melissa@fccgreensboro.org
Both can be reached by phone at 336.273.4725.
Child/Youth #1
Name *
Date of Birth *
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/
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/
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Grade in School and Name of School *
Child/Youth #2
Name
Date of Birth
MM
/
DD
/
YYYY
Grade in School and Name of School
Child/Youth #3
Name
Date of Birth
MM
/
DD
/
YYYY
Grade in School and Name of School
Child/Youth #4
Name
Date of Birth
MM
/
DD
/
YYYY
Grade in School and Name of School
Parent/Guardian #1
Name *
Phone number *
Email address *
Address *
Parent/Guardian #2
Name
Phone number
Email address
Address
Emergency Contact
Name *
Phone *
Drop off/Pick up
Who will usually be dropping off and picking up your child? *
Is there anyone who does NOT have permission to pick up your child?
Does your child have permission to leave church after youth group on his/her own or with a friend? *
Health Information
Does your child have any allergies? If so, please describe.
Does your child have any medical conditions or special needs we should know about? If so, please describe.
Permission
I give my child(ren) permission to participate in this program. I approve of and authorize the transporting of my child in a church-owned or private vehicle for activities within Guilford County. I authorize staff and volunteers to act for me according to their best judgement in an emergency requiring medical attention. *
I give permission for electronic images of my child(ren) to be used online and on social media.
Clear selection
By adding my name here, I agree to the above permissions as indicated and acknowledge that the above information is correct. *
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