Pine Grove Baptist Church

Child's Name (required)

Parent's Name (required)

Your Address (required)

City (required)

Phone Number (required)

Child's Age (required)

Child's Grade just completed (required)
---4 yrsKindergarten1st2nd3rd4th5th6th

Shirt Size (required)
---YXSYSYMYLSML

Medical Info (if any)

Emergency Contact(required)

Van Pickup and Drop-off (required)
---yesno

Who will pick up your child each day, if riding van write "van" (required)

Any additional information you would like to provide

May we have permission to photograph your child (required)
---yesno

May we have permission to use your child's photograph for promotion (required)
---yesno