Morning Study

Blue

 

Kid's Edition Registration

Parent's Name: *
First Name
Middle
Last Name
Address:
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Main Contact Phone:*
Is this a: *
Other Phone 1:
Is this a:
Other Phone 2:
Is this a:
Email:
(1) Child's Name: *
First Name
Middle
Last Name
Age:
Date of Birth:
Please list any allergies your child has:
Special Notes (nursing, cloth diapers, etc.):
(2) Child's Name:
First Name
Middle
Last Name
Age:
Date of Birth:
Please list any allergies your child has:
Special Notes (nursing, cloth diaper, etc.):
(3) Child's Name:
First Name
Middle
Last Name
Age:
Date of Birth:
Please list any allergies your child has:
Special Notes (nursing, cloth diaper, etc.):
(4) Child's Name:
First Name
Middle
Last Name
Age:
Date of Birth:
Please list any allergies your child has:
Special Notes (nursing, cloth diapers, etc.):
----------Please fill in emergency contact information.----------
Emergency Contact Name:
First Name
Middle
Last Name
Relationship to Child(ren):
Emergency Contact Phone 1:
Is this a:
Emergency Contact Phone 2:
Is this a:
PHOTO/VIDEO RELEASE I give permission for images of my child/children captured by regular Kid's Ministry activities through video and photo to be used solely for Bethany Ministry promotional materials, publications, and website.

Digital Signature: