First Baptist Church Crystal Beach

Kids for Christ Registration Form 2023/2024

Students Name (Required)

Parent/ Guardian Name (Required)

Parent/ Guardian Email

Parent/ Guardian Phone Number (Required)

Physical Address (Required)

Mailing Address/ PO Box

Gender

Male

Female

Birthday

Please add your students birthdate

Age Group (Required)

Medical Information

Please list any medical issues, conditions, or allergies your student may have.

Secondary Emergency Contact

Please list a secondary emergency contact (name, number, and relation to student)

Pick up persons

Please list the names of anyone who is authorized to pick up your student.

Any other information we may need to know?

First Baptist Church Crystal Beach

1260 Hwy 87, Crystal Beach, Tx 77650