Flip-A-Tin Family Form

Fill out this form if you are a parent or guardian and you’re coming with your family.

Date: Wednesday, October 31 at 5:30pm Time: 5:30pm - 8:00pm Cost: Free Location: Centralia Faith Tabernacle

Details: We will gathering at the church to be sent out door-to-door in teams for the collection of non-perishable food items for our local food bank. Once our routes are finished, we’ll meet back at the church to celebrate.

Parent/Guardian Name(s) *
Parent/Guardian Name(s)
Primary Phone Number *
Primary Phone Number
Release of Care
According to our Plan to Protect Policy your signature releases the care of your child(ren) over 12 to Centralia Faith Tabernacle from the time they leave the property until they are returned back to CFT. If they are under 12 years old, they will remain in your care for the duration of the evening and you will be responsible for them. 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. 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.
Privacy Policy
Any personal information given will not be used or disclosed except for the purpose of the Family Flip-A-Tin event 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 Family Flip-A-Tin purposes informing about upcoming events, cancellations, or changes occurring.
Consent *
By typing your name and submitting this form you are agreeing to all of the policies listed above.