Child's Name [1]
Date of Birth
Child's Name 2 [same household]
Child's Name 3 [same household]
Parent/Guardian Name
Secondary Contact
Additional Information
By checking, I agree to FBC's Waiver of Liability: WAIVER OF LIABILITY
By checking, I understand the authorized pick up person will have the check-in / check-out sticker that matches the child's sticker.
By checking, I understand that my child[ren] may get wet or messy during fun games and activities. I will check the schedule appropriately to be informed about the next upcoming activity.
By checking, I have indicated in allergy information above in "additional information".
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Have Questions?
Don't hesitate to reach out!
office@fbchopkinsville.com
270-886-1216
1400 South Main Street
Hopkinsville, KY 42240
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