Date: Wednesdays at 7pm starting September 11

Cost: Free

Location: Centralia Faith Tabernacle

Ages: All ages

Bus: The bus from Murphy's Bus Lines leaves CFT at 6:30pm and picks up children at stops along the route through Centralia and Huron Park. It departs again at 8:10 to bring them back to the bus stop. Contact the office to find out your bus stop.

Requirements: Registration is required for each child 18 and under. Children under the age of 4 must be accompanied by a parent or guardian in order to attend. Please carefully read the policies below that help to keep everyone safe while participating in events at CFT.

Mother's Name

First Name

Last Name

Father's Name

First Name

Last Name

Guardian's Name

First Name

Last Name

Children live with

Mom

Dad

Guardian

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Primary Phone Number

(###)

###

####

First Child's Information

Child's Name

First Name

Last Name

Birthday

YYYY

Please list any allergies or medical conditions

Second Child's Information

Child's Name

First Name

Last Name

Birthday

YYYY

Please list any allergies or medical conditions

Third Child's Information

Child's Name

First Name

Last Name

Birthday

YYYY

Please list any allergies or medical conditions

Fourth Child's Information

Child's Name

First Name

Last Name

Birthday

YYYY

Please list any allergies or medical conditions

Release of Care

According to our Plan to Protect Policy your signature releases the care of your child(ren) to Centralia Faith Tabernacle from the time they get on the bus or you drop them off at the church until they are returned back to the bus stop or you pick them up. Once they are returned to the bus stop or picked up they are released back into your care. If you give permission for your child(ren) to walk or bike, written consent from you is required before we can release them to leave the church property. This consent recognizes that all reasonable precautions will be taken to prevent accidents or injuries. Permission is given to allow supervision to seek emergency medical treatment. I have read and understand the Privacy Policy and Release of Care Policy above and I hereby acknowledge on behalf of my son/daughter to absolve the church for any liability whatsoever.

Any personal information given will not be used or disclosed except for the purpose of the Fusion program at Centralia Faith Tabernacle. Pictures and/or names of children may be used for the purpose of promotion, celebration and to give information both in-house and on our social media sites. To protect the privacy of our children, no names will be listed or tagged by CFT. Email will be used strictly for Fusion purposes informing about upcoming events, cancellations, or changes occurring.

Consent

Consent is given for my child to participate in Fusion

Consent is given to take pictures and videos of my child(ren) in accordance with the privacy policy.

Stay in the Loop

Yes! I would like information on upcoming community events.

Type your name here to consent

By typing your name and submitting this form you are agreeing to all of the policies listed above.