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Register For Amplify
for kids 3-yr-old* through grade 6
*3-yr-olds must be potty trained and have turned 3 by September 1
PARTICIPANT INFORMATION
Participant's First Name
Participant's Last Name
Address
City
State
Zip Code
Participant's Birthday
Gender
Female
Male
Current Grade/Age
Younger than Pre-K
Pre-K
K
1
2
3
4
5
6
Allergies, Medical, and Special Needs
PARENT INFORMATION
Parent/Guardian Name
Primary Phone Number
Email
Emergency Contact Name
Emergency Contact Number
Authorized Pickup #1
Authorized Pickup #2
Authorized Pickup #3
Authorized Pickup #4
Do you regularly attend First Free Church?
Yes
No
If you attend church elsewhere, which church do you attend?
Do we have permission to photograph your child?
Yes
No
Do we have permission to use your child's photograph in church media publications?
Yes
No
Other helpful information, comments, or concerns:
Submit
