FIRST FRATT REGISTRATION

COVID WARNING – As recommended by health experts, including the CDC, please wear a mask; social distancing will be enforced. Anyone previously exposed to COVID should quarantine before exposing yourself to others.

Student First Name

Student Last Name

Birthday

Grade Level

School

ISD

Present Overall GPA

T-Shirt Size

2nd Student First Name

Student 2 Last Name

Birthday 2

Grade Level 2

School

ISD

Present Overall GPA

T-Shirt Size

3rd Student First Name

Student Last Name

Birthday

Grade Level

School

ISD

Present Overall GPA

4th Student First Name

Student Last Name

Birthday

School

ISD

Present Overall GPA

T-Shirt Size

Grade Level

T-Shirt Size

Primary Parent Contact Info:

First Name

Last Name

Phone

Street Address

City

State

Postal / Zip code

Emergency Contact Info:

Name

Phone

Parent Volunteers:

Would you consider being a parent volunteer

Yes

Maybe

Pick up and Drop off:

Who is authorized to have custody of your child? (Please list all names below)

Allergies/Food or Otherwise:

List all food allergies for each child below

BEHAVIOR: Student agrees to following behavioral norms that would be accepted at school or any public assembly. If any participant, child, parent, intern or leader ever conducts themselves in an inappropriate way, an immediate and appropriate action will take place to de-escalate the disruption. Our program is built on a :60-:90 minute schedule for most events, so in all likelihood, the parent/guardian would be called upon for immediate pick up of their child should he/she misbehaves.

MASKS: Student agrees to wear a mask while participating during this COVID season unless we have an outdoor activity in which social distancing would be normative.

I give Ken-Lyn Consultants full permission to use pictures and videos created for the use of promoting their programming for the purposes of helping other youth and families

DISCLAIMER: I will not hold Dr. Kenneth and Lynda Brown, Ken-Lyn Consultants, nor Kingdom Outreach Center for any diagnosis of COVID related to non-neglectful actions by any staff of First Fratt. The aforementioned are making strides to serve my family and community and have not ill intent to cause harm to my child, nor the community.

Parent Signature

Date

Please continue to complete Intake and Agreement Form