First Southern Baptist Church of Yuma

Child's Name (required)

Parent's Name (required)

Address (required)

Your Email

Phone Number (required)

Child's Age (required)

Child's Grade last completed(required)

3 year old (must be potty trained)Pre School 4 and 5 year oldKindergarten1st grade2nd grade3rd grade4th grade5th grade6th grade

May we have permission to photograph or video your child? (required)

YesNo

Would your child like to ride the van to and from the church? (required)

YesNo

Allergies (if any)

Any additional information you would like to provide