JFC Children's Ministry Registration Form
Jackson Friends Church Children's Program
Parent/Legal Guardian First Name *
Your answer
Parent/Legal Guardian Last Name *
Your answer
Relationship to Child(ren) *
Your answer
Mailing Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Email Address
Your answer
Phone Number *
Home or Cell
Your answer
In the event of an emergency, I authorize first aid or medical treatment for each child named below, and I release Jackson Friends Church from any and all responsibility in connection therewith. *
Required
#1 - Child's First Name *
Your answer
#1 -Child's Last Name *
Your answer
#1-Child's Birthdate *
MM
/
DD
/
YYYY
#1- Grade *
Your answer
#1 - Special Instructions/Allergies
Your answer
#2 - Child's First Name
Your answer
#2 -Child's Last Name
Your answer
#2 -Child's Birthdate
MM
/
DD
/
YYYY
#2 - Grade
Your answer
#2 - Special Instructions/Allergies
Your answer
#3 - Child's First Name
Your answer
#3 -Child's Last Name
Your answer
#3 -Child's Birthdate
MM
/
DD
/
YYYY
#3 - Grade
Your answer
#3 - Special Instructions/Allergies
Your answer
#4 - Child's First Name
Your answer
#4-Child's Last Name
Your answer
#4 -Child's Birthdate
MM
/
DD
/
YYYY
#4 - Grade
Your answer
#4 - Special Instructions/Allergies
Your answer
#5 - Child's First Name
Your answer
#5-Child's Last Name
Your answer
#5 -Child's Birthdate
MM
/
DD
/
YYYY
#5 - Grade
Your answer
#5 - Special Instructions/Allergies
Your answer
Submit
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