Blue Ridge Boulevard United Methodist Church   
5055 Blue Ridge Boulevard
Kansas City, Missouri   64133
816-353-1435

LOGOS REGISTRATION FORM

Please fill out the form below to register you child in the Blue Ridge LOGOS program.
When finished, click the submit button.  You will soon receive a call from one of our staff. Thank You!

For any questions regarding the LOGOS program
please contact Tammy Bartley at 816-353-1435 or email her at:  tbartley@blueridgechurch.org

Youth/Child Last Name:             First Name:
(Space provided below to add additional children.)           Age:            Birthday: (Month, day, year)
School Attending  
Parent's/Gaurdian's Last Name:      

First Name(s): 

Address
City
Zip
Home Phone
Work Phone
Cell Phone
Email
Parent's Church
Do you need child care for younger siblings while you are here on Wednesday Nights? Yes     No
I give permission for my child/children to be photographed and/or videotaped.  Yes     No               

We will sometimes publish photos in our newsletter, publish them on our website and/or show on Sunday mornings during worship service as slide show. We never give the identity of the children.

In case of medical emergency, the LOGOS ministry personnel are authorized to take my child to the hospital. Hospital preference:
Please list any behavioral, dietary or medical concerns we should know about that may affect the student's participation in LOGOS:

(Unless you have other children to register, you may now submit your registration)
(Second) Youth/Child Last Name:             First Name:
            Age:             Birthday: (Month, day, year)
(Third) Youth/Child Last Name:              First Name:
            Age:             Birthday: (Month, day, year)
(Fourth) Youth/Child Last Name:              First Name:
            Age:             Birthday: (Month, day, year)
(Fifth) Youth/Child Last Name:              First Name:
            Age:             Birthday: (Month, day, year)

Questions?  Contact:
tbartley@blueridgechurch.org
revised 08/07/07