TeamKID Age Group *

(for 2019/20 School Year)

Nursery

3 Years-PreK

Kindergarten-2nd Grade

3rd Grade-5th Grade

Child's Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Parent(s) Name(s)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent(s) Phone Number

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Will your child be riding the FBC bus?

Yes

No