Kid's Club Registration

Student Information

Student's Name

Age

Birthdate

Grade/Class

School

Student's Email (if applicable)

Student's Phone (if applicable)

Allergies

Medical Conditions or Special Instructions

Family Information

Guardian's Name

Secondary Guardian Name

Address

Guardian's Email

This address will receive a confirmation email

Phone (mobile number preferred for text updates)

Persons Authorized to Pick Up Child

Emergency Contact

Relationship to Child

Emergency Release Form: I give my permission to the staff of Family Worship Center to seek medical attention for my child if necessary while participating in Pioneer Club functions. I understand that all necessary precautions will be taken for my child's safety. I will not hold the church, church staff or church volunteers liable.

I agree

Payment Information

1. The fee covers the materials your student will need for the year, including a handbook, t-shirt, and badges/awards. There may be additional costs (optional) throughout the year for extra-curricular activities.
2. You can make your payment for Kids Club online via a credit or debit card with a Visa, MasterCard, American Express, or Discover logo. Just fill out the information below and click "Submit". There is a processing fee added to the amount due.
3. If you would like to pay with cash or check please select the "Pay On Site" option below. You can make your payment at the Welcome Center before or after any service. If you select this option, you do not need to fill out any credit card information below. You can click the "Submit" button and complete the registration.
4. If you need to make payments, you can email us at info@myfwc.church and we will help you make arrangements. A $15 deposit is required to hold your space.

Option

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Kid's Club Registration

Description

Please Fix the Following