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KBC Student Registration

* Student First Name

* Student Last Name

* Grade

Please enter ONLY a number for Grade

* Gender

Male Female

* Birthdate

Shirt Size

* Student Address

Apartment No.

* City

* State

* Zip Code

* Beach Club Location

select one

select one
Altruria Elementary (Bartlett City Schools, Tennessee)
Annistown Elementary (Gwinnett County Public Schools, Georgia)
Austin Elementary (Mesquite ISD, Texas)
Bailey Elementary (Hillsborough County Public Schools, Florida)
Barbers Hill Intermediate North (Barbers Hill ISD, Texas)
Bayless Elementary (Lubbock ISD, Texas)
Bell Manor Elementary (H-E-B ISD, Texas)
Bon Lin Elementary (Bartlett City Schools, Tennessee)
Caillet Elementary (Dallas ISD, Texas)
Canton Intermediate (Canton ISD, Texas)
Carroll Elementary (Carroll ISD, Texas)
Carroll Elementary (Corsicana ISD, Texas)
Charleston Elementary (Charleston Public Schools, Arkansas)
Curlew Creek Elementary (Pinellas County Public Schools, Florida)
Cypress Woods Elementary (Pinellas County Public Schools, Florida)
Dove Elementary (Grapevine-Colleyville ISD, Texas)
Eisenhower Elementary (Pinellas County Public Schools, Florida)
EK Key Elementary (Calcasieu Parish Public Schools, Louisiana)
Ellendale Elementary (Bartlett City Schools, Tennessee)
Emma B Ward Elementary (Anderson County Public Schools, Kentucky)
Eustace Primary/Intermediate (Eustace ISD, Texas)
Grapevine Elementary (Grapevine-Colleyville ISD, Texas)
Hillsboro Intermediate (Hillsboro ISD, Texas)
Hodges Elementary (Mesquite ISD, Texas)
Hood-Case Elementary (Alvin ISD, Texas)
Kemp Intermediate (Kemp ISD, Texas)
Kimball Elementary (Mesquite ISD, Texas)
Lancaster Elementary (Orange County Public Schools, Florida)
Mabank Intermediate (Mabank ISD, Texas)
McCall Elementary (Aledo ISD, Texas)
Midway Elementary (Seminole County Public Schools, Florida)
Moore Elementary (Arlington ISD, Texas)
Moss Elementary (Mesquite ISD, Texas)
Motley Elementary (Mesquite ISD, Texas)
Norman Binkley Elementary (Metropolitan Nashville Public Schools, Tennessee)
Norwood Elementary (Burleson ISD, Texas)
Oak Elementary (Bartlett City Schools, Tennessee)
Oakwood Terrace Elementary (H-E-B ISD, Texas)
Orange Grove Elementary (Pinellas County Public Schools, Florida)
Panter Elementary (Paulding County Public Schools, Georgia)
Peaks Mill Elementary (Franklin County Public Schools, Kentucky)
Pearson Elementary (Garland ISD, Texas)
Pine Street Elementary (Rockdale County Public Schools, Georgia)
Polk Avenue Elementary (Polk County, Florida)
Poynter Elementary (Crowley ISD, Texas)
Range Elementary (Mesquite ISD, Texas)
Rock Springs Elementary (Orange County Public Schools, Florida)
Rockenbaugh Elementary (Carroll ISD, Texas)
Rugel Elementary (Mesquite ISD, Texas)
Rutherford Elementary (Mesquite ISD, Texas)
Seabourn Elementary (Mesquite ISD, Texas)
Seminole Elementary (Pinellas County Public Schools, Florida)
Shady Oaks Elementary (H-E-B ISD, Texas)
Southaven Intermediate (DeSoto County Schools, Mississippi)
St Martin Upper Elementary (Jackson County, Mississippi)
Stamping Ground Elementary (Scott County Schools, Kentucky)
Stephen F Austin Elementary (Goose Creek Consolidated ISD, Texas)
Tarkington Intermediate (Tarkington ISD, Texas)
Taylor Elementary (Burleson ISD, Texas)
Three Points Elementary (Orange County Public Schools, Florida)
Tildenville Elementary (Orange County Public Schools, Florida)
Utopia School (Utopia ISD, Texas)
Viridian Elementary (H-E-B ISD, Texas)
Westridge Elementary (Franklin County Public Schools, Kentucky)
Wheatley Elementary (Orange County Public Schools, Florida)
Wilshire Elementary (H-E-B ISD, Texas)
Winnsboro Memorial Intermediate (Winnsboro ISD, Texas)
Woodlawn Elementary (East Baton Rouge Parish, Louisiana)
My school isn't listed

School Name & City

Parent/Guardian 1

* First Name

* Last Name

* Mobile Phone

* May we have permission to text you with questions or additional updates

Yes No

* Email

Please enter only one valid email address

Permission to pick up student after club

Yes No

Would you be willing to volunteer in your student's Beach Club?

Yes No

Church Information

* Do you attend church?

Yes No

Name of church

If you don't attend church, what is your religious preference?

Student Pickup (Please complete if plan to be in-person)

My student will be picked up

Yes No

My student has permission to walk home

Yes No

My student has permission to ride their bike home

Yes No

My student attends the after-school child care after Beach Club

Yes No

Student Medical/Allergies

Student Food Allergies?

Student Medical Needs?

Parent/Guardian 2

First Name

Last Name

Mobile Phone

Email

Please enter only one valid email address

Permission to pick up student after club

Yes No

Additional Emergency Contact Required for In-Person Beach Club, (in the event parents/guardians cannot be reached during club)

First Name

Last name

Mobile Phone

Permission to pick up student after club

Yes No

In addition to parent/guardian and emergency contact, my student has permission to be picked up by

From time to time KiDs Beach Club® or the partnering church may take photographs/video to capture the fun kids have at Beach Club.

Information provided on this form will be provided to KiDs Beach Club® and the local partnering church. We promise to only send a reasonable amount of communication each month. You may unsubscribe at any time, beginning with our first contact.

T-shirts are provided at the discretion of the partnering church.

With my electronic signature below, I certify I am the parent, guardian or other adult with legal parental authority to complete this registration form, and give my permission as a parent or legal guardian for this student to attend Beach Club. I have reviewed, understand and agree to the KBC Privacy Policy and the Authorization and Release of Liability.

* Type Full Name

* Type Email

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KBC Online Student Registration Form