First Brethren Church of Gratis

Date Oh Registration

First Name

Last Name

Last Grade Completed

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Parent/Guardian First Name

Last Name

Phone Number

(Emergency Contact) First Name

Last Name

(Emergency Contact) Phone Number

Allergies

Medical Conditions

Persons other than Parent/Guardian Authorized to Pick Up Child

Home Church

Anything else you would like to share?

sunday school 9:30 am
morning worship 10:30
wednesday night 7:00