REGISTRATION FORM:

Currently serving 93455, and 93454 (Must be 5 years old or older)

Parent or Legal Guardian Name (required)

First Child & Grade (required)

Second Child & Grade

Third Child & Grade

Do you have additional children you desire to register?
Yes

Your Contact Information

Your Email (Required)

Contact Number (required)

Pick Up Address: House number and Street (required)

City (required)

State

Zip Code (required)

Emergency Contact Information

Emergency Contact Name:
Emergency Contact Number:
Emergency Contact Address:



Name of your Church (Optional)

BUS TRANSPORTATION IS REQUESTED

YES

Your Message

Permission: By checking the box below I understand that I'm granting permission to Lighthouse Baptist Church to pick up the above named children on their bus and carry them to the church where they will be instructed in the teachings of the Bible including, but not limited to, the biblical foundations of our liberties. The children will be returned home after church and the Bus Driver will see that the child enters the home before he departs. If no one is home to receive the child/ren, Lighthouse Baptist Church will contact the parents and arrange for the parents to pick up their child or children.

Yes