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Online Family Registration Card
Children's Ministry at Bent Creek Baptist Church
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Parent/Guardian Name 1
*
Your answer
Email
*
Your answer
Cell Number
*
Your answer
Relationship to Child
*
Mother
Father
Legal Guardian
Grandparent
Stepmother
Stepfather
Other:
Does this adult live at the address below?
*
Yes
No
Parent/Guardian Name 2
Your answer
Email
Your answer
Cell Number
Your answer
Relationship to Child
Mother
Father
Legal Guardian
Grandparent
Stepmother
Stepfather
Other:
Clear selection
Does this adult live at the address below?
Yes
No
Clear selection
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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