BPC Kids & Youth Registration
Please fill out a form for each child in your household.
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Email *
Child's Full Name *
Grade in School *
Child's Birthday *
Dietary Restrictions/Allergies/Medical Concerns *
Parent/Guardian 1 Name & Phone Number *
Parent/Guardian 2 Name & Phone Number
Mailing Address (for birthday cards)
I authorize Bettendorf Presbyterian Church to take photos of my student and understand they may be used for promotion of activities or events. *
Would you like to sign up for the kids or youth newsletter? *
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