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Bethel Baptist Church
Children's Ministry Registration Information

Child's Name
(Last, First,Middle):

Gender:

Gender

Birth Date
(MM/DD/YYYY):

Grade
Completed:

Parent/Guardian:

Cell Phone:

Home Phone:

Work Phone:

Email:

Address:

City, State, Zip:

Emergency Contact:

Phone:

Medical Issues or Concerns:

Food Allergies:

Food Allergies

If yes, please list:

(Note:  If your child requires an 'epi-pen' type injection for medical emergencies, please conference with Children's Coordinator before leaving the child in our care.)

As the parent or guardian responsible for the welfare of the child named above, I give my permission for the Children's Department staff of Bethel Baptist Church, Deer Park, Texas, to care for my child according to the parental information and policies in place.

Signature of Parent or Guardian:

Date:

Date Entered:

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