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111 Drum Point Road • Brick, NJ 08723
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brick.presbyterian@verizon.net
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2023-2024 Student Church School Registration
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2023-2024 Student Church School Registration
2023-2024 Student Church School Registration
Kathy Kenny
2023-08-25T18:37:27+00:00
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Date:
Student's Name: Last name, first name, nickname
Birthdate:
Grade:
Address:
Allergies/medical concerns:
Other concerns we should be aware of:
Primary Contact:
Parent
Other (relationship)
Name (Ms., Mr.)
Phone number:
Okay to text?
Yes
No
Address:
Email:
Second Contact:
Parent
Other (relationship)
Name (Ms., Mr.)
Phone number:
Okay to text?
Yes
No
Photo Release: Brick Presbyterian Church has my permission to use my child's photograph publicly in BPC materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
I grant permission
I do not grant permission
Signature of Parent/Guardian
Date
Submit
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