JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
BUMC Kids Registration
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's First, Middle, and Last Name
*
Your answer
Preferred Name
*
Your answer
Gender
*
Your answer
Birthdate (MM/DD/YYYY)
*
Your answer
Age as of 8/1/2022
*
Choose
0
1
2
3
4
5
6
7
8
9
10
11
12
Address
*
Your answer
Guardian’s Name
*
Your answer
Guardian’s Phone #
*
Your answer
Guardian 2’s Name
Your answer
Guardian 2’s Phone #
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone #
*
Your answer
Please list any medical conditions, allergies, activity restrictions, or other information of which you wish us to be aware.
*
Your answer
By typing your full name, you agree to BUMC’s registration agreements
listed here
.
*
Your answer
I do not give permission for my child to be photographed or used in BUMC's social media or advertisements.
Check here
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
