Kids Zone — Berean Bible Fellowship

Kids Zone Registration Form: Please include all children attending

Name of Child

First Name

Last Name

Date of Birth

MM

DD

YYYY

Grade Completed

Age

Siblings Attending

Please include their names and ages on the line below

Parent/Guardian

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Emergency Contact Name & Number

Special Needs / Allergies / Other Concerns