FPU Childcare Registration Registration only needs to be completed for one family member attending the class. Please provide the appropriate answers below for any additional family member attending the class or childcare reservations. *First Name*Last Name*Email Address*Phone Number*Address Line 1Address Line 2*City*State/Province/Region*Zip/Postal Code*Attendee's Gender:FemaleMale* Attendee's Birthday Hint: From the Calendar View, Click on the Month/Year to see a drop-down list for changing the Month/Year!*Attendee's Marital Status:SingleMarriedWidowedDivorcedEngaged*Will there be another family member attending with you?:YesNoAddt'l Family Member's First & Last Name:Addt'l Family Member Gender:FemaleMaleAddt'l Family Member's Birthday:Addt'l Family Member's Mobile #:Childcare reservations are required for all weekly FPU. Central Kids programming is provided free of charge for children who are six weeks old through 5th Grade.*Do you need childcare for the weekly classes?:YesNoDo you agree to allow Central Christian Church to use photos, videos or statements of your child in church-created publications, media releases, information displays, websites, social media and/or other electronic media. No personal address, phone number or email address will be included. Please answer Yes or No for each child that will be in our care during this event.:Child #1 First & Last Name:Child #1 Gender:FemaleMaleChild #1 Birthday ~ Please select (or type) the birthday with the CORRECT year. Hint: From the Calendar View, Click on the Month/Year to see a drop-down list for changing the Month/Year!Child #1 Grade (if applicable):-- Select --Younger than KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeChild #1 Allergy / Special Need:Child #1 Photo/Media Release:YesNoChild #2 First & Last Name:Child #2 Gender:FemaleMaleChild #2 Birthday:Child #2 Grade (if applicable):-- Select --Younger than KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeChild #2 Allergy / Special Need:Child #2 Photo/Media Release:YesNoChild #3 First & Last Name:Child #3 Gender:FemaleMaleChild #3 Birthday:Child #3 Grade (if applicable):-- Select --Younger than KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeChild #3 Allergy / Special Need:Child #3 Photo/Media Release:YesNoChild #4 First & Last Name:Child #4 Gender:FemaleMaleChild #4 Birthday:Child #4 Grade (if applicable):-- Select --Younger than KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeChild #4 Allergy / Special Need:Child #4 Photo/Media Release:YesNo Submit Form C3 Online Login Not Logged In Show Summary (0) Public Links Event Calendar Online Giving Mission Trip Registration Secure Links My User Account My Giving My Purchase History My Contribution Statement My Groups My Events My Subscriptions My Mission Trips
