Page 132 | Providence Baptist Church

Child's Name (Required)

Age (Required)

TeamKID is for children 3 years old, who are potty-trained, through 6th grade.

Date of Birth (Required)

Enrolled in Grade (Required)

Has not attended school

Pre-K

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

Street Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Allergies or other health concerns

Parents (Required)

E-Mail address (Required)

Phone Number(s) (Required)

In addition to parents, the following are authorized to pick up my child.

I give permission for my child to be photographed. (Required)

Providence Baptist Church