BBC KIDS REGISTRATION FORM

STUDENT #1 - First, Middle & Last Name:

Birthdate:

Age:

Grade:

School Child Attends:

Gender: Gender: Male Female

Are there any allergies of which we need to be aware?

Are there any special considerations of which we need to be aware?

Is there anything else we should know about your child?

My child plans to attend: My child plans to attend: Sunday AM Kids Church/Nursery AWANA - (STOP & complete AWANA-specific form)

STUDENT #2 - First, Middle & Last Name:

Birthdate:

Age:

Grade:

School Child Attends:

Gender: Gender: Male Female

Are there any allergies of which we need to be aware?

Are there any special considerations of which we need to be aware?

Is there anything else we should know about your child?

My child plans to attend: My child plans to attend: Sunday AM Kids Church/Nursery AWANA - (STOP & complete AWANA-specific form)

STUDENT #3 - First, Middle & Last Name:

Birthdate:

Age:

Grade:

School Child Attends:

Gender: Gender: Male Female

Are there any allergies of which we need to be aware?

Is there anything else we should know about your child?

Are there any special considerations of which we need to be aware?

My child plans to attend: My child plans to attend: Sunday AM Kids Church/Nursery AWANA - (STOP & complete AWANA-specific form)

Mailing Address (Street, City, ZIP):

Phone Number:

Father/Guardian Name:

Mother/Guardian Name:

Email Address:

Email Address:

Name/relationship of other(s) authorized to pick up my child(ren), if any:

Phone number of other(s) authorized to pick up my child(ren):

Name/relationship of other(s) authorized to pick up my child(ren):

Phone number of others(s) authorized to pick up my child(ren):

Is there any custodial information of which we should be aware? If so, please specify:

Do you give permission to take your child(ren)'s picture for classroom projects, print, church website, church videos or Facebook? Do you give permission to take your child(ren)'s picture for classroom projects, print, church website, church videos or Facebook? Yes No

HOME CHURCH:

By completing this form you are attest that the information on the form is true and accurate to the best of your knowledge. I UNDERSTAND THAT THIS FORM DOES NOT REGISTER MY CHILD(REN) FOR AWANA. I must complete a separate form for AWANA registration. (Please note that AWANA is on Sunday mornings at 9:15am). By completing this form you are attest that the information on the form is true and accurate to the best of your knowledge. I UNDERSTAND THAT THIS FORM DOES NOT REGISTER MY CHILD(REN) FOR AWANA. I must complete a separate form for AWANA registration. (Please note that AWANA is on Sunday mornings at 9:15am). I agree with the above statements.

Please type your name:

Today's Date

FOR OFFICE USE ONLY - Add to BBC Kids Mailchimp

FOR OFFICE USE ONLY - Add to Remind

FOR OFFICE USE ONLY - Pass on to Church Office

FOR OFFICE USE ONLY - Add to Planning Center, etc.