2025-2026 Wednesday Night Child/Youth Registration • Belleview Baptist Church

First Name *

Last Name *

Gender *

Date of Birth *

Current Grade *

Tip: Choose "Pre-K" if your child is at least 3 years old and has not yet begun Kindergarten.

Guardian First Name *

Guardian Last Name *

Phone Number *

Email Address

Home Address *

Mailing Address (Optional)

Home City *

Home State *

Home Zip Code *

May we send you text announcements about the Children's Ministry to the cell phone number(s) shown above? *

Yes

May we use your child's picture in club photos, videos, promotional materials and on the church website? (Child's name won't be included) *

Yes

Does this child have any allergies? *

Yes

What allergies do they have? (If none, select "No" above.)

Who has permission to pick up your child/children? *

Who does NOT have permission to pick up your child/children? (If no, leave blank)

In case of an emergency and the parent or guardian cannot be reached during VBS time.

Name *

Cell Phone *

Relation to Child *