Faith Builders Registration

Mondays, March 2nd – 30th, 2026 from 6:00-7:30pm | Please click submit when you've completed the form.

Parent/Guardian Information

Name

*

Email

This address will receive a confirmation email

Phone

*

Address

*

Child's Information

Child's Full Name

*

Last grade completed in school:

*

Please select one option.

Kindergarten 1st 2nd 3rd 4th 5th

Medical and/or other important information concerning your child. (Please include food allergies):

2nd Child's Information

2nd Child's Full Name

Last grade completed in school:

Please select one option.

Kindergarten 1st 2nd 3rd 4th 5th

Medical and/or other important information concerning your child. (Please include food allergies):

3rd Child's Information

3rd Child's Full Name

Last grade completed in school:

Please select one option.

Kindergarten 1st 2nd 3rd 4th 5th

Medical and/or other important information concerning your child. (Please include food allergies):

Emergency Contact

Full Name

*

Phone

*

Full Name

Phone

By submitting this form you agree to give Lycoming Centre permission to photograph your child and use their photo for promotional purposes.

Please click

*

Please select all that apply.

I agree

Description

Mondays, March 2nd – 30th, 2026 from 6:00-7:30pm

Please click submit when you've completed the form.

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