Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Photo/Media Release *

By checking yes below, I give permission for pictures/videos of my children to be used in all FBC Albemarle, including but not limited to website, social media, and promotional materials.

Yes, I give permission.

No, I do not give permission.

Parent/Guardian Name *

First Name

Last Name

Phone # *

(###)

###

####

Parent/Guardian Name

First Name

Last Name

Phone #

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country