Kids Club | Springfield Baptist Church

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Contact Email

Family Name

Parent/Guardian Name(s)

Child #1 Name

Allergies or Medical Conditions

Child #2 Name

Allergies or Medical Conditions

Child #3 Name

Allergies or Medical Conditions

Child #4 Name

Allergies or Medical Conditions

Child #5 Name

Allergies or Medical Conditions

Address

Town/City

Parent Phone Number

Alternate Contact Name

Alternate Contact Phone Number

Pick Up Person(s):

I allow my child to be photographed for use within the program (craft/activity)

I allow my child to be photographed for the newspaper and/or church website/social media

Comments/Questions?