KidsZone Registration 2022-2023
Please fill out this form and click submit.
KidsZone will take place on Sunday evenings, beginning September 11, 2022
Child's Name
*
Date of Birth
*
Grade
*
Please select one option.
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
Select Option
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
Parent Email
*
This address will receive a confirmation email
Parent Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Allergy/Medical Information
*
Would you like to receive communication from Bethany?
*
Please select all that apply.
Texts
Emails
Both
No, Thank You
Photo Release: Photos will be taken throughout the program activities. I give my permission for my child to be in these photos that may be used in promotional materials and on Bethany Baptist Church's social media accounts. Please sign here by entering your first and last name as a signature.
*
Submit
Description
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