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The following information will be listed in our files and in the membership directory.  Please either update your information if it has changed or check the box indicating that all information we have on file is the same.   Also, please update your child's grade level in school (this information is used by the playgroups and we need to update it in our membership database). 

Please return this form along with your $25 membership fee (checks made payable to FCM) to Lara-Membership Coordinator: 2621 Park Green Way, Glen Allen, VA 23060

For any questions, please contact Lara at  membership@fcmrichmond.org  or  804-553-4639.

Pictures for the directory MUST be emailed to Maggi at maggi814@yahoo.com.  Only emailed photos will be accepted.  Please note: Any photos previously used in the directory will continue to be used unless a new photo is emailed. 

________ Yes I have updated my Child's Current Grade Level
________ All Information is the same as listed in the 2009 Directory

Parent(s) name__________________________________________________________________________________________________________

E-mail___________________________________________________________________________________________________________________

Address _________________________________________________________________________________________________________________

Phone number(s) ______________________________________  DTC/LID (if waiting) _________________________________________


Child's name__________________________________________     Grade in School _______________________________________________

Birthday ______________________________________________      Adoption day   ________________________________________________

SWI  _________________________________________________      Province  ______________________________________________________

Adoption Agency _____________________________________      Homestudy Agency ___________________________________________


Child's name__________________________________________     Grade in School _______________________________________________

Birthday ______________________________________________      Adoption day   ________________________________________________

SWI  _________________________________________________      Province  ______________________________________________________

Adoption Agency _____________________________________      Homestudy Agency ___________________________________________


Child's name__________________________________________     Grade in School _______________________________________________

Birthday ______________________________________________      Adoption day   ________________________________________________

SWI  _________________________________________________      Province  ______________________________________________________

Adoption Agency _____________________________________      Homestudy Agency ___________________________________________


Other children (w/DOB/Grade in School)_______________________________________________________________________________

__________________________________________________________________________________________________________________________