Child Referral Application

    Parent/Guardian Name

    Relationship to Child

    Child’s Full Name

    Grade:

    Race:

    Date of Birth

    Sex

    Address

    Address Line 2

    City

    State

    Zip Code

    Phone Number

    Phone:
    Work Phone:

    Your Email:

    I give permission:

    • For my child to participate in The Father’s Child Ministry
    • To use my child’s photograph and first name for the purpose of publicity efforts by The Father’s Child Ministry
    • To have my child complete questionnaires containing questions about personal
      interests
    • For the staff of The Father’s Child Ministry to visit my child at school during regular
      school hours
    • For my child to have a mentor

    I grant Permission

    Parent or Guardian Questions About Child:

    Are there any chronic health problems concerning your child that the FCM staff needs to be informed about?

    What do you believe are your son or daughter’s gifts and talents?

    What are some activities you feel that your son or daughter enjoy doing?

    What are some areas that your child can use some help?

    Consent Form for “Identifying Information” in The Father’s Child Ministry
    Promotional Materials

    I give my permission for The Father’s Child Ministry to use the following information:
    name, photograph, comments and interests. This information shall be used by The Father’s Child Ministry solely for promotional purposes.

    In giving this consent, I release The Father’s Child Ministry, and their employees from
    any obligation or liability otherwise owed to me in connection with any personal or
    proprietary right I may have as a result of the sale, reproduction or use of the above
    referenced identifying information. This consent may be terminated at any time by me.
    This consent will be valid as long as the volunteer or child is actively involved in The
    Father’s Child Ministry.

    I grant Permission


    THE FATHER’S CHILD MINISTRY STATEMENT OF FAITH AGREEMENT

    The Father’s Child Ministry is a 501 c (3) Christian organization whose vision is to see
    The Father’s children receive the love of the Heavenly Father. Our mission is to
    influence The Father’s young men and women to reach their potential through a
    relationship with Jesus Christ by utilizing community resources.

    Statement of Faith

    We believe the bible to be inspired, the only infallible, authoritative Word of God. We
    believe in the deity of Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His
    ascension to the right hand of the Father, and in His personal return in power and glory.

    By submitting this agreement, as a volunteer in The Father’s Child Ministry, you are in
    agreement with FCM’s statement of faith and will abide by this statement when
    volunteering your time in The Father’s Child Ministry

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