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Summer Blast 2025
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Child Information
First Name
First Name cannot contain special characters such as quotes, parentheses, etc.
First Name cannot contain emojis or special fonts.
First Name is required.
Last Name
Last Name cannot contain special characters such as quotes, parentheses, etc.
Last Name cannot contain emojis or special fonts.
Last Name is required.
Birthdate
Jan
Feb
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1
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2025
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1902
1901
1900
Birthdate cannot be a future date.
Gender
Male
Female
Gender is required.
2024-2025 School Year Grade (completing this May/June)
4 & 5 Years Old
Kindergarten
1st
2nd
3rd
4th
5th
2024-2025 School Year Grade (completing this May/June) is required.
Allergies or Medical Conditions
No
Yes
Allergies or Medical Conditions is required.
Parent / Guardian Information
First Name
First Name is required.
Last Name
Last Name is required.
Mobile Phone
Mobile Phone is required.
By entering your mobile number and submitting this form, you agree to receive automated text messages from First Church of God at the number provided.
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Email
Email address is not valid
Email is required.
Relationship to Child (Parent, Grandparent, etc.)
Relationship to Child (Parent, Grandparent, etc.) is required.
Photo Release
I grant First Church of God, its representatives and employees the right to take photographs of
my child
. I authorize First Church of God, its assignees and transferees to copyright, use and publish the same in print and/or electronically. I agree that First Church of God may use such photographs of
my child
with or without his/her name for any lawful purpose, including, for example such purposes as publicity, illustration, advertising and web content.
I Agree to the Photo Release
Yes
No
I Agree to the Photo Release is required.
Emergency Medical Release
I give my permission for
my child
to participate in
Summer Blast 2025
sponsored by First Church of God. In the unlikely event of an emergency, I grant permission for the church to authorize and consent to any x-ray, medical or surgical diagnosis for treatment or hospital care to be rendered under the general or special supervision and on the advice of a licensed physician, surgeon, anesthesiologist, dentist, or other qualified medical personnel acting under their supervision in the treatment found necessary for the correction of conditions considered detrimental to the health and well being of
my child
. I understand and I am liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to
my child
.
I Agree to the Medical Release
Yes
I Agree to the Medical Release is required.
Submit