Kids Bible Club Sign Up | Glory Church Pike County

Child Registration Form

We're so excited for you to join us at Glory Church's first ever Kids Bible Club this summer! It will be a great day packed with safe and age-appropriate activities for your child, all while learning about God's plan for their life! Snacks and lunch are included, and participation is free. Please note that your child must be at least 4 years old to participate. Filling out this form will help us prepare to serve you and your family well. Questions? Reach out to Pastor Lucas at glorychurchpike@gmail.com.

Parent/Guardian's First Name

Parent/Guardian's Last Name

Mailing Address

Phone

Can we text you on this number?

Yes

Child's First and Last Name

Child's Date of Birth

Child 2 - First and Last Name

Child 2 - Date of Birth

Child 3 - First and Last Name

Child 3 - Date of Birth

Please list any allergies for your child(ren) below.

Please list any dietary restrictions for your child(ren) below.

Please list any medical or behavioral considerations for your child(ren) below.

Will your child(ren) need transportation to or from Bible Club? We will have church vans available for pickup and drop off in the Pikeville area. (Select all that apply)

Pick Up for Bible Club

Drop off After Bible Club

No Transportation Needed

If needed, physical address for pick up and/or drop off:

If there are additional adults who may pick up your child, please list name(s) here.

My permission is granted for Glory Church and its staff and volunteers to obtain necessary medical attention in case of sickness or injury to my child.

I understand that my child may be photographed or videotaped while participating in the activities and events sponsored by Glory Church, and give my permission and consent to allow these photographs or videotapes to be used in promotional materials.

Thank you! Your regstration has been successfully submitted!