SHINE Kids Zone Registration
Register your child now for SHINE Kids Zone 2017-2018 year at Southside Baptist Church in Carthage, Texas! We kick-off on Wednesday, September 13th, 2017, at 6:30 pm!

Here's the Scoop! SHINE Kids Zone is a weekly kids program that encourages children to become disciples for Jesus! Each week, your child will learn a new lesson from the Bible and be encouraged to share their lesson with their families and friends.

Date Started: Wednesday, September 13th
Time (Every Wednesday) 6:30-7:30 pm

If you have questions, you can contact Jessica Grimes at (903)926-4669 or email: jgrimes_01@hotmail.com.

Name of Child *
Your answer
Grade in School *
Child's Date of Birth (Month/Date) *
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Parent Name(s) *
Your answer
Mailing Address *
Your answer
Phone Number for Parents *
Your answer
Please provide your email address: *
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Emergency Contact Name and Phone Number (In the event parent cannot be reached) *
Your answer
Does your child have any special needs or allergies(Food, medication, etc)? Please explain.
Your answer
I hereby give my permission for my child to participate in SHINE Kids Zone 2017-2018 year at Southside Baptist Church. I assume all risks of injury, damage, or other harm or inconvenience that occurs at SHINE Kids Zone 2017-2018 year at Southside Baptist Church, and I agree not to hold Southside Baptist Church, or any individual associated with the church, liable or responsible. I will also do everything possible to ensure that I or the emergency contact person can be reached at all times while my child is participating in SHINE Kids Zone 2017-2018 year at Southside Baptist Church. *
Photo Waiver: Pictures will be taken during SHINE Kids Zone 2017-2018 year at Southside Baptist Church and maybe posted to the church website, a Facebook album or used in other presentations. No names will be included with the photos.I give permission for a photo or likeness of my child to be used in the manner described above. *
Is your family a member of a church in our area? If so, please tell us where.
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