PK Club Registration

Register for the current year PK Club program

Tuition:
Tuition is $45 per 7 week session, payable at the beginning of each session.

Family Name

Child #1

Child #2

Child #3

Child #4

Sessions:

Session One Session Two

Parents/Guardians:

and

Address:

Phone Numbers: use ###-###-#### format

Home:

Dad Work: Dad Cell:

Mom Work : Mom Cell:

Email Address (*required):

Emergency Contact:

Medical Insurance: Carrier: Policy # Group #

Physican:

Food Allergies?

Please list any condition(s) that might effect your child(ren)/youth and list medications:

Medical Release:

By clicking below, I authorize First Presbyterian Church of Farmington to seek medical assistance for my child(ren) while participating in the LOGOS program. I also will assume responsibility for any costs incurred for my child(ren)'s medical treatment.

I Agree Date:

Permission to be Photographed and/or Videotaped

I give my permission for my son/daughter, to be photographed and/or videotaped for publicity materials to be used by

First Presbyterian Church or for inclusion on the church’s website. Names will not be used.

I Agree No, I prefer my child(ren)'s image not be used on the website. Date:

First Presbyterian now processes online registrations through PayPal. No PayPal account is required. You can use your debit or credit card.

Youth Programs Children Teens Preschool