Parent 1 Name *

First

Last

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Parent 1 Phone *

Parent 1 Email *

Parent 2 Name

First

Last

Does Parent 2 reside at the same address as Parent 1? *

• Yes
• No

Parent 2 Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Parent 2 Phone

Parent 2 Email

Child's Name *

First

Last

Birthdate *

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Grade in school as of September 1st *

• Junior Preschool
• Senior Preschool
• Kindergarten
• First Grade
• Second Grade
• Third Grade
• Fourth Grade

Allergies

Medications

Conditions that would be helpful for a teacher to know

Would you like to enroll another child? *

• Yes
• No

Second Child's Name *

First

Last

Birthdate (Second Child) *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Grade in school as of September 1st (Second Child) *

• Junior Preschool
• Senior Preschool
• Kindergarten
• First Grade
• Second Grade
• Third Grade
• Fourth Grade

Allergies (Second Child)

Medications (Second Child)

Conditions that would be helpful for a teacher to know (Second Child)

Would you like to enroll another child? *

• Yes
• No

Third Child's Name *

First

Last

Birthdate (Third Child) *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Grade in school as of September 1st (Third Child) *

• Junior Preschool
• Senior Preschool
• Kindergarten
• First Grade
• Second Grade
• Third Grade
• Fourth Grade

Allergies (Third Child)

Medications (Third Child)

Conditions that would be helpful for a teacher to know (Third Child)

Would you like to enroll another child? *

• Yes
• No

Fourth Child's Name *

First

Last

Birthdate (Fourth Child) *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Grade in school as of September 1st (Fourth Child) *

• Junior Preschool
• Senior Preschool
• Kindergarten
• First Grade
• Second Grade
• Third Grade
• Fourth Grade

Allergies (Fourth Child)

Medications (Fourth Child)

Conditions that would be helpful for a teacher to know (Fourth Child)

I GIVE MY PERMISSION FOR MY CHILD(REN) TO LEAVE THE CHURCH BUILDING ACCOMPANIED BY A TEACHER TO BE IN THE FELLOWSHIP GARDEN AND PLAY ON THE PLAYGROUND. *

• I CONSENT
• I DO NOT CONSENT

I CONSENT TO MY CHILD(REN) ATTENDING FPCW FOR ANY FUNCTION BEING PHOTOGRAPHED. I AGREE THAT FPCW SHALL HAVE THE RIGHT TO USE MY CHILD'S PHOTO FOR MARKETING/PROMOTIONAL MATERIALS AT ANY TIME AND FOR ANY OTHER LEGITIMATE PURPOSE THE MINISTRY DEEMS NECESSARY. THE CHILD'S NAME WILL NOT BE USED WITH THE PHOTOS. *

• I CONSENT
• I DO NOT CONSENT

Submit

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