2018-2019 Preschool & Children's Choirs Registration
Child's First Name *
Your answer
Child's Last Name *
Your answer
Birthday *
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Age *
Your answer
Grade *
School Name *
Your answer
Allergies & Special Instructions *
Your answer
Child's First Name
Your answer
Child's Last Name
Your answer
Birthday
MM
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DD
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YYYY
Age
Your answer
Grade
School Name
Your answer
Allergies & Special Instructions
Your answer
Child's First Name
Your answer
Child's Last Name
Your answer
Birthday
MM
/
DD
/
YYYY
Age
Your answer
Grade
School Name
Your answer
Allergies & Special Instructions
Your answer
Child's First Name
Your answer
Child's Last Name
Your answer
Birthday
MM
/
DD
/
YYYY
Age
Your answer
Grade
School Name
Your answer
Allergies & Special Instructions
Your answer
Name(s) of Parent(s)/Guardian(s) *
Your answer
Address *
Your answer
City, State & Zip Code *
Your answer
Phone Number *
Your answer
Phone type *
Phone Number
Your answer
Phone type
E-mail address *
Your answer
Does your family regularly attend church? *
If yes, where?
Your answer
Emergency Contact Name & Relationship to the child *
Your answer
Emergency Contact Phone *
Your answer
The following people (adults only) have permission to drop off/pickup my child(ren): *
Your answer
Media Release Statement & Signature *
I am aware that photographs or video may be taken of Bloomfield Baptist Church (BBC) Family Ministry participants during events, activities, and classes. I release BBC and its representatives from responsibility for any harm or invasion of privacy that may occur or be produced by taking photographs or video of my child. I certify that I have read the above authorization, release, and agreement, and fully understand what this document says. I give BBC and its representatives permission to use photographs or video that include my child in any and all media products for promotion, art, advertising, editorial or other purpose. This may include but is not limited to newsletters, both physical and electronic, posters, brochures, ads, post cards and web pages. By selecting "I agree" in the box below you agree to the Media Release Statement.
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