BBC Kids Registration and Liability Form

Valid until August 31, 2026

Name (Required)

Email Address (Required)

First Name: (Required)

Child's First Name

Last Name: (Required)

Child's Last Name

Grade (Required)

Age (Required)

Address: (Required)

Emergency Contact #1: (Required)

Please enter the name, relationship to child and number of the emergency contact.

Emergency Contact #2: (Required)

Please enter the name, relationship to child and number of the emergency contact.

Allergies/Medical Information: (Required)

Please list any allergies or medical information that we need to be aware of while your child is in our care.

I give permission for my child to be photographed and photos used on our church website/FaceBook. (Required)

I give permission for my child to participate in the activities at BBC and do not hold BBC responsible. (Required)

Any Special Needs or Concerns: (Required)

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury... (Required)

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my participation at Bethlehem Baptist Church facilities. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless Bethlehem Baptist Church, its staff and volunteers, of all claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of Bethlehem Baptist Church, its staff and volunteers.

Parent/Guardian Signature: (Required)

Date: (Required)

Solve 2 + 7 = ?

Bethlehem Baptist Church

1841 North Rocky River Road
Lancaster, SC 29720

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