Foothills Baptist Church - AR - C.H.A.O.S. Youth Registration Form

C.H.A.O.S. YOUTH REGISTRATION

Please fill out this form for each youth you are registering.
Fill out completely.
C.H.A.O.S. YOUTH meets every Wednesday
when school is in session @ 5:30 PM
Supper will be served each Wednesday Night

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Gender

Birthdate

Parent or Guardian First Name

Last Name

Parent or Guardian Phone

Emergency Contact

Relationship to Student

Emergency Contact Phone Number

Email

School Grade

Allergies or medical issues

May we take photos of your student?

Yes

No

Does your student need a ride?

Yes

No

Who can pick up your student?

Parents/Guardians: PLEASE READ CAREFULLY AND ACKNOWLEDGE. IF YOU SELECT NO, THEN YOUR CHILD WILL NOT BE ABLE TO PARTICIPATE IN C.H.A.O.S. YOUTH.
By submitting this form, you release Foothills Baptist Church, it’s volunteers and staff, from any liability of injury to you child as a result of an accident. You also authorize medical treatment, and if needed, transportation to the nearest hospital, in case of an emergency. Do you accept? (select yes or no below)

Yes

No

C.H.A.O.S. YOUTH REGISTRATION

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