2017-2018 Children's Ministries Registration

Family's Last Name*
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Number of children you are registering
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Child 1 First Name*
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Please select the ministries for which this child is registering:

(select all that apply)

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Birthday Month*
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Birthday Day*
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Birthday Year*
Enter year number

Grade Entering (Fall 2018)
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School Attending
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Other School
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Teacher (Homeroom Teacher)
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Does this child have any allergies? *
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Please check all that apply:
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Please be specific and give instructions:
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Does he/she carry an EPI Pen?
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Does this child take any medication on a regular basis? *
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Medication for:*
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Medication Name:*
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Does he/she have a Bible?
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Child 2 First Name*
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Please select the ministries for which this child is registering:

(select all that apply)

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Invalid Input

Invalid Input

Invalid Input

Invalid Input

Birthday Month*
Invalid Input

Birthday Day*
Invalid Input

Birthday Year*
Enter year number

Grade Entering (Fall 2017)
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School Attending
Invalid Input

Other School
Invalid Input

Teacher (Homeroom Teacher)
Invalid Input

Does this child have any allergies? *
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Please check all that apply:
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Please be specific and give instructions:
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Does he/she carry an EPI Pen?
Invalid Input

Does this child take any medication on a regular basis? *
Invalid Input

Medication for:*
Invalid Input

Medication Name:*
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Does he/she have a Bible?
Invalid Input

 

 

Child 3 First Name*
Invalid Input

 

Please select the ministries for which this child is registering:

(select all that apply)

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Birthday Month*
Invalid Input

Birthday Day*
Invalid Input

Birthday Year*
Enter year number

Grade Entering (Fall 2017)
Invalid Input

School Attending
Invalid Input

Other School
Invalid Input

Teacher (Homeroom Teacher)
Invalid Input

Does this child have any allergies? *
Invalid Input

Please check all that apply:
Invalid Input

Please be specific and give instructions:
Invalid Input

Does he/she carry an EPI Pen?
Invalid Input

Does this child take any medication on a regular basis? *
Invalid Input

Medication for:*
Invalid Input

Medication Name:*
Invalid Input

Does he/she have a Bible?
Invalid Input

 

 

Child 4 First Name*
Invalid Input

 

Please select the ministries for which this child is registering:

(select all that apply)

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Birthday Month*
Invalid Input

Birthday Day*
Invalid Input

Birthday Year*
Enter year number

Grade Entering (Fall 2017)
Invalid Input

School Attending
Invalid Input

Other School
Invalid Input

Teacher (Homeroom Teacher)
Invalid Input

Does this child have any allergies? *
Invalid Input

Please check all that apply:
Invalid Input

Please be specific and give instructions:
Invalid Input

Does he/she carry an EPI Pen?
Invalid Input

Does this child take any medication on a regular basis? *
Invalid Input

Medication for:*
Invalid Input

Medication Name:*
Invalid Input

Does he/she have a Bible?
Invalid Input

 

 

Child 5 First Name*
Invalid Input

 

Please select the ministries for which this child is registering:

(select all that apply)

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Birthday Month*
Invalid Input

Birthday Day*
Invalid Input

Birthday Year*
Enter year number

Grade Entering (Fall 2017)
Invalid Input

School Attending
Invalid Input

Other School
Invalid Input

Teacher (Homeroom Teacher)
Invalid Input

Does this child have any allergies? *
Invalid Input

Please check all that apply:
Invalid Input

Please be specific and give instructions:
Invalid Input

Does he/she carry an EPI Pen?
Invalid Input

Does this child take any medication on a regular basis? *
Invalid Input

Medication for:*
Invalid Input

Medication Name:*
Invalid Input

Does he/she have a Bible?
Invalid Input

 

 

Child 6 First Name*
Invalid Input

 

Please select the ministries for which this child is registering:

(select all that apply)

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Birthday Month*
Invalid Input

Birthday Day*
Invalid Input

Birthday Year*
Enter year number

Grade Entering (Fall 2017)
Invalid Input

School Attending
Invalid Input

Other School
Invalid Input

Teacher (Homeroom Teacher)
Invalid Input

Does this child have any allergies? *
Invalid Input

Please check all that apply:
Invalid Input

Please be specific and give instructions:
Invalid Input

Does he/she carry an EPI Pen?
Invalid Input

Does this child take any medication on a regular basis? *
Invalid Input

Medication for:*
Invalid Input

Medication Name:*
Invalid Input

Does he/she have a Bible?
Invalid Input

 

Family Contact Information

 

Street Address*
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City*
Invalid Input

State*
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Zip*
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Father Last Name
Please let us know your name.

Father First Name
Please let us know your name.

Father Email
Please let us know your email address.

Father Phone (where you can be reached during ministry events)
Enter phone number: 123-456-7890

Mother Last Name
Please let us know your name.

Mother First Name
Please let us know your name.

Mother Email
Please let us know your email address.

Mother Phone (where you can be reached during ministry events)
Enter phone number: 123-456-7890

Automated phone messages are occasionally sent out regarding special events. Please enter the phone number you would like us to use.
Enter phone number: 123-456-7890

 

During our Wednesday programs, we will always call 911 first in an emergency!

 

In the event of an emergency, please tell us who you would like us to call if one of the parents cannot be reached.

 

Emergency Contact
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Emergency Contact's Phone
Enter phone number: 123-456-7890

Emergency Contact's Relationship
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TRANSPORTATION PERMISSION

(For Club 119:11, Journey 56, and Junior Choir and from BASD schools only)

 
By affixing your initials and entering your full name below you are agreeing to give permission for your child(ren) registered above to ride the provided transportation to Mount Bethel Church on Wednesdays, beginning September 20, 2017, to attend Club 119:11, Journey 56, and/or Junior Choir. 
In the event your child is absent from school or will not be participating for other reasons you must notify the church so the child’s name can be removed from the weekly transportation list. 
If you do not notify the church prior to 2pm we are required to pick them up.

 

Initials*
Please enter your initials

Parent Full Name*
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MEDIA PERMISSION

 

I hereby grant Mount Bethel Church the right to obtain and/or use my child's photograph, digitized image, video and/or voice recording for educational and informational purposes.*
You must authorize the media release form

 

 

CHURCH INFORMATION

 

Does your family currently attend Mount Bethel Church?
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Current Church Attending
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Would you like more information about participating in the ministries of Mount Bethel Church?
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Important note: We love adult volunteers but we can't accept your help unless you have submitted the church volunteer application form and been approved.