Visitor Registration Form
Hello and thank you for visiting Imagine Kids Ministry at Bethel Christian.
Please complete this form while you are onsite.  For future visits, you can check-in by using your last name at any of the 2 Check-in kiosks. Please  note, photos and video of kids services may be used for promotional purposes. 


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Email *
Parent/Guardian Name (First and Last) *
Relationship to Child(ren) *
Street Address *
City, State, and Zip *
Phone Number *
Child #1 Name (First and Last) *
Child #1 Date of Birth *
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DD
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YYYY
Child #1 Grade *
Child #1 Gender *
Child #1 Allergies / Medical Conditions
Child #2 Name (First and Last)
Child #2 Date of Birth
MM
/
DD
/
YYYY
Child #2 Grade
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Child #2 Gender
Clear selection
Child #2 Allergies / Medical Conditions
Child #3 Name (First and Last)
Child #3 Date of Birth
MM
/
DD
/
YYYY
Child #3 Grade
Clear selection
Child #3 Gender
Clear selection
Child #3 Allergies / Medical Conditions
Child #4 Name (First and Last)
Child #4 Date of Birth
MM
/
DD
/
YYYY
Child #4 Grade
Clear selection
Child #4 Gender
Clear selection
Child #4 Allergies / Medical Conditions
My child(ren) may be released to the person listed above OR one of the following people: (Name and phone number)
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