C-STREET KIDS (a Ministry of College Street Baptist Church) Registration 2019-2020
I am Registering for: *
Child #1 Name *
First and Last Name
Child #1 Please list any food allergies that your child has: *
Child #1 Please list any allergies/concerns that your child has: *
Child #1 Age *
Child #1 Current Grade *
Child #2 Name
First and Last Name
Child #2 Please list any food allergies that your child has:
Child #2 Please list any allergies/concerns that your child has:
Child #2 Age
Child #2 Current Grade
Clear selection
Child #3 Name
First and Last Name
Child #3 Please list any food allergies that your child has:
Child #3 Please list any allergies/concerns that your child has:
Child #3 Age
Child #3 Current Grade
Clear selection
Parent/Guardian Name *
First and Last Name
Complete Address/Apartment # *
Street Address with Apartment #, City, SC
Cell Phone # *
Email Address *
OK to Photo/Video Your Child(ren) for Children's Ministry Related Purposes? *
Person(s) authorized to pick up your child *
In Case of Emergency Contact Name *
First and Last Name
Emergency Contact Phone # *
Parent/Guardian Signature *
Submitting this form will serve as parent/guardian signature that your child (children) can attend College Street Baptist Church MARK Club Program 2019-2020 school year and permission to ride the church bus if applicable. Please type your First and Last Name
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