Berean Kids Registration Form

Berean Kids

2015-16 Registration From


Please fill out this form for each of your children.



Child's Name:*
First Name:
Last Name:
Date of Birth:*
Parent/Guardian Name(s):*
First Name:
Last Name:
Allergies or Medical Alerts:
We photograph the kids of Berean throughout the year (for special events & activities) and would like to share these pictures on our website and bulletin boards. We do not put any information (including names) of the children on the internet. If it would be okay to use your kids’ pictures, please sign the release below. “I give permission to Berean Baptist Church to use my children’s photographs on their website and bulletin boards. I release them from any responsibility of harm that may arise from the inclusion of the photographs on their website.” By clicking "yes" you are agree with the above statement.*
Workers are to release children in their care to parents, guardians or persons specifically authorized to pick up the children. Only children in 1st grade or higher may be exempted. By marking "yes" I hereby relinquish Berean Baptist Church, it's employees and volunteers from all responsibility for any damage to property or injury to others that may result from my child being unsupervised. I understand that if problems result from my child being unsupervised that this exemption can be revoked by Berean Baptist Church or the parent. If a teacher wishes to speak with you, they have the authority to hold your child until you come to pick them up.
If you are exempting your 1st-5th grade child from supervision, where will they be meeting you?
Enter the text you see in the security image: