Online Family Registration Card
Children's Ministry at Bent Creek Baptist Church
Parent/Guardian Name 1 *
Your answer
Email *
Your answer
Cell Number *
Your answer
Relationship to Child *
Does this adult live at the address below? *
Parent/Guardian Name 2
Your answer
Email
Your answer
Cell Number
Your answer
Relationship to Child
Does this adult live at the address below?
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Please list the names of individuals, other than the parents/guardians listed above, who are authorized to pick up your child. *
Your answer
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