DBC Kids Brite Registration

"DBC Kids" Registration - David Baptist

Sunday Mornings @ David Baptist Church in Kings Mountain, NC * 9:45am - 12:00 Noon * Ages First through Sixth Grade
Name*

First NameLast Name
Gender:*

MaleFemale
Date of Birth

MonthDayYear
Date
Last Grade Completed*
For Pre-K, Enter "0"
Name of Home Church
Email
example@example.com
Address*

Street Address

Street Address 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.
Emergency Contact Person*

First NameLast Name
Relationship to Child*
Emergency Contact Phone Number*
Please enter a valid phone number.
Who can pick up your child?*
Allergies or Other Medical Conditions:
I hereby grant permission for David Baptist Church to record sounds, images and/or video of my child, blanks* while attending this DBC Kids Program. I also give permission for David Baptist Church, at its sole discretion, to use these sounds, images and/or videos in publications (including print, websites, and social media platforms) owned by David Baptist Church in relation to this DBC Kids Program.
Signature of Parent/Guardian and Date: blank*
Should be Empty:

"DBC Kids" Registration - David Baptist