2023-2024 Wednesday Night Child Registration • Belleview Baptist Church

Child Information

First Name *

Last Name *

Date of Birth *

Gender

Grade (Choose One) *

Does Your Child Have Any Allergies? *

Yes

What Allergies Do They Have?

Parent/Guardian Info

Home Address *

Home City *

Home Zip Code *

Home State *

Home Phone *

Mailing Address Same as Home Address? *

Yes

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Parent/Guardian 1 First Name *

Parent/Guardian 1 Last Name *

Parent/Guardian 1 Cell *

Parent/Guardian 1 E-mail *

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Cell

Parent/Guardian 2 E-mail

Pictures:

May we use your child's picture in club photos, video, promotional materials and on the church web site (child's name will not be included)? *

Yes

May we send you Children's Ministry announcements via text? *

Yes

Emergency Information

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

Emergency Contact First name *

Emergency Contact Last Name *

Emergency Contact Street Address *

Emergency Contact City *

Emergency Contact State *

Relation to Child *

Emergency Phone (Cell) *

Emergency Phone (Home) *

Belleview Baptist Church Check-In/Check-Out Policy

Dear Parents/Guardians,

For the safety of your children, we require that all children be checked in and checked out for each club
meeting. Check-in will be in individual club rooms. Please read over the policy details and complete the form below.

Check-in for all clubs will be in the Gathering Place. To ensure that club begins on-time, please check-in between 6:45pm and 7pm.
Please list below the name(s) of anyone who has permission to pick up your child(ren), or NOT pick them up. Photo I.D. may be requested. (If at any time you wish to add or drop a name on the list, please do so, in-person, during sign-in.)
We always welcome parents to join us for club, but before you can do this, you will need to sign-in and pick up a visitors pass. Again, we are doing this for the safety of your children.
Check-out for all clubs is at 8:00pm and will be in the individual meeting rooms (signs will be posted).
If you have any questions, please contact the, John Rowland, at 859-905-8341.

Check-Out Permissions

I give my permission for the following people to pick up my child. I understand if someone other than who is
listed below arrives to pick them up, my child will not be released. Photo I.D. may be requested.

Names of those allowed to pick up your child:

Are there any specific individuals who DO NOT haver permission to check out your child: