Backyard Bible Club Registration

August 2nd | 6:30-8:30PM
This year there are three locations for Backyard Bible Club!
East Fayetteville 1073 E Bonnie Ln. Farmington 252 New York Ave. Elkins 13227 Tuttle Subdivision Rd

Please check our church Facebook & Instagram for any weather updates.

* Indicates required field

Child's Name *

First

Last

Please list other children you are registering (including Age & Grade). *

Backyard Bible Club Location *

Age *

Last grade completed *

Parent/Guardian Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Mailing Address (if different) *

Line 1

Line 2

City

State

Zip Code

Country

Phone Numbers and Email

Home Phone *

Work Phone *

Mobile Phone *

Email *

Medical Information or other information we need to know.
(Please include any food or other allergies)

Medical Information *

Emergency Contacts (other than listed above)

Emergency Contact 1 - Name *

Emergency Contact 1 - Phone Number *

Emergency Contact 2 - Name *

Emergency Contact 2 - Phone Number *

Dismissal Information
Who may pick up your child at the end of each Backyard Kids Club if you are dropping off?

Name of the person(s) who may pick up your child. *

Other Information

Do you attend church? If so, where? *

May we have permission to photograph your child? *

Yes No

May we have permission to use your child's photograph for the purpose of promotion, including social media? *

Yes No

Submit

Backyard Bible Club Registration

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