First Baptist Church Wednesday Evening Youth Program Registration
This form is required for you to fill out before coming to our Wednesday Evening Youth Programs. You and your household only need to fill this form out once! Please separate each name by a comma. You must be 18 or older to fill out this form.

Masks are required to wear when inside the church. Social distancing will be promoted as best as possible. All volunteers will adhere to safety protocols. We are committed to keeping you and your child safe.

We are excited to see you again or for the first time!

Event Timing: 1st & 3rd Wednesdays from 6-7pm
Event Address: 200 N Mill ST Colfax, WA 99111

Cubbies - 3-5yrs
Explorers - K-2nd Grades
Grapple - 3rd-6th Grades
Email address *
Name of your kid(s) and Grade Level - please enter a comma between each kid's name if applicable (i.e. Susan Anderson 5th, Tim Anderson 3rd, etc.) *
Birth Date - Name followed by date in the following format mm/dd/yyyy; comma between each kid(s) name if applicable (i.e. Susan Anderson 04/10/2009, Tim Anderson 06/17/2012, etc.) *
Parent(s) Name (First and Last name) *
Home Address *
Contact Number (Cell/Work; both if applicable) *
Emergency Contact Name (First and Last name) *
Emergency Contact Number (Cell/Work; both if applicable) *
Second Emergency Contact Name/ Number (Highly recommended)
Please list any allergies or medical conditions. If you are listing for multiple kids, please designate the kid and condition together, separate each combination by a comma (i.e. Susan Anderson Peanuts, Tim Anderson Bees, etc). If you have no allergies or medical conditions, write "None". *
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