Hillcrest Baptist Byram, MS - Hillcrest Kids Child Registration Form

Hillcrest Kids Registration Form

Date Input

Child's First Name

Child's Last Name

Child's Birthdate

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Allergies

Please list who is allowed to pick up your child. (We will only release your child to individuals listed.)

Has your child accepted Christ as their savior?

Primary Parent or Guardian's First and Last Name

Secondary Parent or Guardian's First and Last Name

Phone Number

Alternate Phone Number

Signature