Childs Name (required)
Grade completed as of end of May 2018 3-4 yearsK123456
Childs Age
Parents Name (required)
Physical Address (required)
Mailing Address (if different)
City, Zip
Cell Number
Phone Number
Is there any Medical/Allergy or Other Info we should know yesno
If so, please fill in here
Permission to photograph your Child during Bible School yesno
Permission to use your childs image or likeness for promotion yesno
Do you attend church? yesno
If so, Where?
Email Address
Parent Signature (by checking below you are certifying that you are the parent or legal guardian of the above child)