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Participant Registration

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Registro en Español

First Church of God

Location

2627 Niles Ave

Saint Joseph, MI 49085

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Contact Micah Lange:

269-369-3171

micah.l@myfirstchurch.com

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Country

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Contact Phone 1

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Home Church Affiliation

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New This Year PRESCHOOL ONLY!!

Pick up Password.

Below there is space for you to provide a pick up password that ANYONE who picks up your child will need to provide. The password can be a numerical sequence (1,2,3,4) or a word ( Poppyseed ). This will be used upon picking up PRESCHOOLERS EACH evening.

Pick up Password.

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Grade Leaving

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Gender

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Date Of Birth

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Allergies/ Medical Concerns

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Comments

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I DO NOT want my child photographed

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