Youth Ministry Registration

If you have more than one child, please fill out each participant's information below. There is space for up to four participants. Only one participant is required to submit the form.

Participant 1 Full Name(*)

Please let us know your name.

Preferred Name

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Birth Date(*)

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Current Age (in years)(*)

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Grade as of Sept. 1(*)

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Baptized?(*)

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Cell Phone Number

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School Currently Attending(*)

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School District(*)

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Special Considerations (including allergies)

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Participant 2 Full Name

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Preferred Name

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Birth Date

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Current Age (in years)

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Grade as of Sept. 1

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Baptized?

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Cell Phone Number

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School Currently Attending

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School District

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Special Considerations (including allergies)

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Participant 3 Full Name

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Preferred Name

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Birth Date

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Current Age (in years)

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Grade as of Sept. 1

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Baptized?

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Cell Phone Number

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School Currently Attending

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School District

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Special Considerations (including allergies)

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Skip this section if you do not have any more participants. Scroll to the bottom to continue.

Participant 4 Full Name

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Preferred Name

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Birth Date

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Current Age (in years)

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Grade as of Sept. 1

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Baptized?

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Cell Phone Number

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School Currently Attending

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School District

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Special Considerations (including allergies)

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Guardian 1 Name(*)

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Preferred Number(*)

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Phone 2

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Email Address(*)

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Preferred Communication(*)

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Mailing Address(*)

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Guardian 2 Name

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Preferred Number

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Phone 2

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Email Address

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Preferred Communication

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Mailing Address

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Guardian 3 Name

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Preferred Number

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Phone 2

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Email Address

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Preferred Communication

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Mailing Address

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Emergency Contact and Relationship(*)

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Emergency Contact Phone Number

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Approved Persons for Pick-up

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Names of Extended Family at BMPC

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Our family would like to participate in the following:

Sign Us Up For the Following eNews:

Children & Families

Nursery (infants, toddlers, 2s)

Youth Ministry

Fine Arts

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Yes, I would like to receive text message reminders for programs.

Yes

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Children & Youth Ministry Registration

Our family would like to participate in the following:

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