Bethel Baptist Church
Saturday, February 22, 2020
A People You'll Call Family. . . a Place You'll Call Home
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A separate form for each participate must be completed.  If you are under 18 yrs, you must have a parent or guardian complete the form.
Child's Name (First and Last):
Parent's Name (First and Last):
 Street Address:
Zip Code:  
Home Phone Number with Area Code:
Work Phone Number with Area Code:
Cell Phone Number with Area Code:
Which is the best contact number?  
Email Address:
Child's Birthdate (00/00/0000): 
Last Grade Child Attended:  
Please list any Allergies, Medical, or Special Needs of Your Child:
Person(s) Authorized to Pick Up Child:
Please list an emergency contact and their number (other than yourself).
Do you attend Church?  If so, enter the name of the church?
  Are you a guest?  If so, who are you a guest of?
May we photograph you child and use it in Church Publications?
Please choose your child's gender:
 Male  Female