Flip-A-Tin Under 18 Form

Fill out this form if your child(ren) are over 12 and will be joining us without parental supervision.

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 *
Parent/Guardian Name
Primary Phone Number *
Primary Phone Number
First Child's Information
Child's Name *
Child's Name
Age *
Age
Second Child's Information
Child's Name
Child's Name
Age
Age
Third Child's Information
Child's Name
Child's Name
Age
Age
Fourth Child's Information
Child's Name
Child's Name
Age
Age
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 are dropped off at CFT until they are picked up by a parent/guardian. 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 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 *
By typing your name and submitting this form you are agreeing to all of the policies listed above.