FPNO Child Registration - New Hope Community Church

Parent/Guardian Name*

Other Parent/Guardian Name

Phone Number*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Which foster agency are you working with?

Child's Name*

Date of Birth*

Gender*

Male
Female

Any Food Allergies?

Any other special needs or important information while caring for this child?

Do you have a second child to register?

Yes
No

Second Child's Name*

Date of Birth*

Gender*

Male
Female

Any Food Allergies?

Any other special needs or important information while caring for this child?

Do you have a third child to register?

Yes
No

Third Child's Name*

Birth Date*

Gender*

Male
Female

Any food allergies?

Any other special needs or important information while caring for this child?

Do you have a fourth child to register?

Yes
No

Fourth Child's Name*

Birth Date*

Gender*

Male
Female

Any food allergies?

Any other special needs or important information while caring for this child?

Do you have a fifth child to register?

Yes
No

Fifth Child's Name*

Birth Date*

Gender*

Male
Female

Any food allergies?

Any other special needs or important information while caring for this child?

Consent*

I have read and agree to the Permission and Liability Release (below)

By selecting I accept you, are adhering to the following Permission and Liability release- I hereby give permission for all listed participants above to participate with New Hope Community Church in our Foster Parent Night Out. I assume all risks which may be involved in the participant's involvement in the activities of New Hope Community Church. I hereby forever release New Hope Community Church, its directors, employees, agents, and members from any liability, claims, or demands of any nature whatsoever which may be incurred while this/these persons is participating in the activities of New Hope Community Church. *

Register Your Child

Foster Parent Night Out

454 Corinth Rd. Queensbury, NY 12804

518.798.5778

[email protected]

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454 Corinth Rd.
Queensbury, NY 12804

518.798.5778

[email protected]