Bluegrass Baptist Church

Register Your Kids, Today!

Child's Name

Last Name

Gender
Boy
Girl

Birthdate

Grade this Fall

Parent/Guardian's Name

Last Name

Parent/Guardian's Number

Parent/Guardian's Email

Address 1

Address 2

Country

City

State

Zip/Postal Code

Name of Home Church

Allergies (yes, please fill in, if no please leave blank)

Known Medical Conditions

Permission to photograph and use photo for promotion
Yes
No