Company

Parent's Full Name *

Phone number *

Residential Address *

Child 1️⃣ | Full Name *

Child 1️⃣ | Date of Birth *

Child 1️⃣ | Gender *

Male Female

Child 2️⃣ | Full Name

Child 2️⃣ | Date of Birth

Child 2️⃣ | Gender

Male Female

Child 3️⃣ | Full Name

Child 3️⃣ | Date of Birth

Child 3️⃣ | Gender

Male Female

Which Church do you attend? *

Bethel AG International Worship Centre Other

Do your kids attend Bethel AG Kids Church? *

Yes No

Any Special prayer request?