Screen Shot 2019-08-15 at 6.55.30 AM.png

REGISTER YOUR CHILD For Bethel 4 Kids CHURCH

We want to keep your child safe and comfortable during Children's Church, so we'll need some information from you to be certain we know all we need to know to make the best experience for your child. Please complete the registration form for you child. More than one child? Please complete a separate form for each.

Bethel 4 Kids Church

Child's Name

First Name

Last Name

Age/Grade

Date of Birth

YYYY

Any Allergies?

Yes

Please describe any allergies or other medical information we should know

Mother's Full Name

Father's Full Name

Guardian's name if other than mother or father

Custody of Child

Both Parents

Mother Only

Father Only

Other

Please explain any custody or guardianship issues that would prevent the child from being released to a parent

Parent/Guardian Address

Home Phone

Cell Phone 1

Cell Phone 2

email address

By checking this box, you give us permission to seek immediate medical assistance in the event of an emergency

Yes, I agree

No, I do not agree

Please list up to four people aged 18 or older who are permitted to pick up your child from Bethel 4 Kids Church. PLEASE LIST THEIR RELATIONSHIP TO YOUR CHILD

Name of the adult who will accompany the child to the Kickoff Breakfast

First Name

Last Name

Go To Kemble Home Page

Bethel 4 Kids Church Form

REGISTER YOUR CHILD For Bethel 4 Kids CHURCH

KEMBLE MEMORIAL UNITED METHODIST CHURCH