Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Parent's Name *

First Name

Last Name

Parent's Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Photo Release *

I/We grant permission to Bethel Church to use photogenic images containing photograph/likeness of the registered student for various purposes such as printed material, publications, displays, video productions, PowerPoint presentations, etc. I also acknowledge Bethel's right to crop of treat the photographic image at its discretion.

Yes

No

Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Parent's Name *

First Name

Last Name

Parent's Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Photo Release *

I/We grant permission to Bethel Church to use photogenic images containing photograph/likeness of the registered student for various purposes such as printed material, publications, displays, video productions, PowerPoint presentations, etc. I also acknowledge Bethel's right to crop of treat the photographic image at its discretion.

Yes

No