Faith Community Church

One Way Club Registration

Family Information

page 1 of 3

Name of Child #1 *


First Name	Last Name

Birthday (Please include year) *

Grade in School *

Allergies and Notes

Name of Child #2


First Name	Last Name

Birthday (Please include year)

Grade in School

Allergies and Notes

Name of Child #3


First Name	Last Name

Birthday (Please include year)

Grade in School

Allergies and Notes

Name of Child #4


First Name	Last Name

Birthday (Please include year)

Grade in School

Allergies and Notes

Contact Information

page 2 of 3

Address *


Address

Address Line 2

City	State	Zip Code

Home Phone Number or Main Contact Number *

Phone Number

Cell Phone Number #1

Phone Number

Whose Cell Phone is This?

Would you like to receive a text message of any cancellations or changes to the One Way Club?

Select all that apply

Yes
No

In order to send a group text, we will need to know your cell phone carrier (eg. U.S Cellular, Verizon, etc.)

Cell Phone Number #2

Phone Number

Whose Cell Phone is This?

Would you like to receive a text message of any cancellations or changes to the One Way Club?

Select all that apply

Yes
No

In order to send a group text, we will need to know your cell phone carrier (eg. U.S Cellular, Verizon, etc.)

Family E-mail Address

Email Address

Can we use your e-mail address to send you up-dates for One Way Club and any up-coming events hosted by Faith EFC for children?

Select all that apply

Yes
No

Emergency Contact Name *

Emergency Contact Number *

Phone Number

* required