BG Kidz Visitors
Please fill out this form and click submit.
Child Name
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Birthdate
*
Grade
*
Please select one option.
None (Birth-crawling)
None (mobile-potty trained)
None (Potty trained-preK)
PreK (starting Kindergarten 2023)
K
1st
2nd
3rd
4th
5th
6th
Select Option
None (Birth-crawling)
None (mobile-potty trained)
None (Potty trained-preK)
PreK (starting Kindergarten 2023)
K
1st
2nd
3rd
4th
5th
6th
Known allergies?
Medical information
Parent Information
Parent/Gaurdian Name
*
Parent/Guardian Email
*
This address will receive a confirmation email
Parent/Guardian Cell Phone
*
Media Waiver
- I hereby grant permission to Beech Grove Baptist Church to use my image/voice in any official church publications---printed or web-based---without further consideration. - I acknowledge the church's right to crop, edit, or otherwise treat any photo's recordings at its discretion. -I also acknowledge that the church may chose not to use my image or voice at this time but may do so at its own discretion at a later date. -I understand that once my image/voice is posted on Beech Grove Baptist Church's website or any of its social media profiles that it may then be downloaded by any computer user, anywhere in the world. -The church reserves the right to discontinue the use of any images/recordings at any time, without notice.
*
Please select one option.
Therefore, I agree to indemnify and hold blameless the church, its pastor, staff, members, and designees from any claims arising from the use of my image or voice.
I do not grant my permission for the church, its pastor, staff, members, and designees to the use of my child's image or voice
Select Option
Therefore, I agree to indemnify and hold blameless the church, its pastor, staff, members, and designees from any claims arising from the use of my image or voice.
I do not grant my permission for the church, its pastor, staff, members, and designees to the use of my child's image or voice
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
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