Family Registration

Parents/Guardians

First Name

Last Name

First Name

Last Name

Phone Number

Preferred Means of Contact

Children

Please fill all areas for each child

First Name

Last Name

Gender

Birthdate

Grade

Allergies

First Name

Last Name

Gender

Birthdate

Grade

Allergies

First Name

Last Name

Gender

Birthdate

Grade

Allergies

First Name

Last Name

Gender

Birthdate

Grade

Allergies

Emergency Contact

First Name

Last Name

Phone Number

Relationship

Persons Authorized for Pick Up

First Name

Last Name

Relationship

Phone Number

First Name

Last Name

Relationship

Phone Number

Persons NOT Authorized for Pick Up

First Name

Last Name

First Name

Last Name

Photo Release

By checking these boxes, I give permission to Bethany Evangelical Free Church to photograph my child and use their pictures on...

Church Website

Social Media (Facebook, Instagram, etc.)

Flyers or Brochures

None of the above

IN CASE OF EMERGENCY, I understand that every effort will be made to contact a child's parent or guardian. In the event I cannot be reached, I hereby give permission for emergency treatment for the listed children in my care. In case of an accident, I hereby release Bethany Evangelical Free Church, any staff member, and/or volunteer from liabilities.

Name

Signature

Date Input

Phone Number

Relationship to Child

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Family Registration

Parents/Guardians

Children

Emergency Contact

Persons Authorized for Pick Up

Persons NOT Authorized for Pick Up

Photo Release

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