BPC Kids & Youth Registration
Please fill out a form for each child in your household.
Sign in to Google to save your progress. Learn more
Email *
Child's Full Name *
Grade in School *
Child's Birthday *
MM
/
DD
/
YYYY
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? *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy