JAM (Jesus And Me) Registration

Complete the form below to register your child for our JAM program. Submit a new form for each child you are enrolling.

As space is available, our local schools will transport children on a bus to the church for JAM. If you wish for your child to ride the bus to JAM, check with your local school regarding space availability and complete the proper transportation consent form for your district. You can download and print the form here.

Mena Schools Bus Consent

CRSD Bus Consent

Student's Name(Required)

First Last

Student's Age(Required)

Student's Grade in School(Required)

Physical Address(Required)

Street Address City State ZIP Code

Mailing Address (if different from Physical Address)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email

Best Contact Phone(Required)

Alternate Contact Phone

Parent/Guardian Employer(Required)

Employer Name Employer Phone

Emergency Contact #1(Required)

First Last

Emergency Contact #1 Phone(Required)

Emergency Contact #2(Required)

First Last

Emergency Contact #2 Phone(Required)

Persons authorized to pick up my child

Please note: only persons listed here will be allowed to pick up this child. (Parents and guardians are not assumed; they must also be listed.) Authorized persons must physically come inside the facility to sign out their child. To ensure safety and security, no students will be released without an authorized adult's signature.

Please inform us of any special dietary needs or allergies for your child. If none, please type "None."(Required)

Please inform us of any medical conditions your child has, or list any medications your child will bring with them. If none, please type "None."(Required)

All medications must be sent in original prescription packaging with the child's name and dosage instructions.

Photo/Video Consent(Required)

I consent to the photographing or videotaping of my child to be used by First Baptist Church of Hatfield in the promotion of the ministries of the church.

I agree and give consent.

I do NOT agree or give consent.

JAM (Jesus And Me) Registration

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