Fellowship Baptist Barboursville

Child Information

First Name

Last Name

Date of birth

Gender

Parent Information

First Name

Last Name

Phone Number

Address

Apartment, suite, etc.

City

State

Postal / Zip Code

Phone Carrier (For Text Updates)

Any physical limitations, allergies, or medication we need to be aware of?

Would you like to be added to our email list for updates on our kids ministry?

Yes

Signature