SBCNE Midweek Ministry Form 2025-26

Springfield Baptist Church 2025-26 Kids' Midweek Ministry

Most Wednesday, following Springfield/Platteview School Calendar 5:30-6:45 Open to Students between K-6th grade ('25-'26 school year)
How many children are you registering?*
Child Information
First Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
25-26 School Year Grade*
Medical or other information we may need to know about the child (including food allergies).*
Second Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
25-26 School Year Grade
Medical or other information we may need to know about the child (including food allergies).
Third Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
25-26 School Year Grade
Medical or other information we may need to know about the child (including food allergies).
Fourth Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
25-26 School Year Grade
Medical or other information we may need to know about the child (including food allergies).
Child Release Information
Parent/Legal Guardian 1 *

First & Last Name

Phone

EmailAddress

Additional CommentsCountry
Parent/Legal Guardian 2

First & Last Name

Phone

EmailAddress

Additional Comments
My child (children) may be released to:

Me or someone I list belowThe child(children) will be walking or riding bikes homeI will text if any changes.Other
Name(s) of Persons to which the child (children) may be released to each night after Wednesday Night Program.

Name / Relationship Name / Relationship
Are there any persons to which the child (children) may NOT be released to?*

YesNo
Who may you child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)*

Name / RelationshipPhone
Emergency Contact 2 (other than parent/guardian listed above)

Name / Relationship Phone
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.

I AgreeI do not agree
We look forward to Wednesdays with the kids this summer.

Should you have questions, please contact Jacque Degner.

Call or Text: (402)917-7401 Email: sbcnekids@outlook.com
Should be Empty:

Springfield Baptist Church 2025-26 Kids' Midweek Ministry

Child Information

First Child

Second Child

Third Child

Fourth Child

Child Release Information

Media Release