Student Registration

Mt Hope Baptist Church Student Activities Registration

* Indicates required field

Parent/Guardian Name #1 *

First

Last

Parent/Guardian Name #2 *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Person(s) generally responsible for Check-In/Pick-UP *

Additional Emergency Contact *

First

Last

Relationship *

Emergency Phone *

Student #1 *

First

Last

Date of Birth *

Age *

School *

Grade *

Child's Relationship To You *

If other, please indicate relationship: *

Student # 2 *

First

Last

Date of Birth *

Age *

School *

Grade *

Child's Relationship To You *

If other, please indicate relationship *

Student #3 *

First

Last

Date of Birth *

Age *

School *

Grade *

Child's Relationship To You *

If other, please indicate relationship *

Do any of the above have food or medication allergies? *

Yes No

Do any of the above have any serious medical or behavioral issues we need to be aware of? *

Yes No

If you answered yes, please list here. *

By submitting this information, I give my permission for my child(ren) listed above to participate in the programs and activities sponsored by Mt Hope Baptist Church Student Ministries. These activities include but are not limited to Sunday School, Midweek Services, VBS, and other special events. I agree that if my child has been sick, is under doctor’s orders not to attend school due to illness, or is running a fever over 99.9, I will withhold them from church activities until they are well enough to participate again.

Submit