RBC Student Ministries Registration 2020-2021
Please fill out a separate form for each child. At the end of the form, you can check the boxes for all the student ministries that you are registering your child for.

*Privacy Policy: For the security of your personal information, the information you share will be password protected and will not be made available to third parties.
Sign in to Google to save your progress. Learn more
Last Name of Child *
First Name of Child *
Date of Birth *
MM
/
DD
/
YYYY
Age of Child *
Grade at School *
Parent(s) Name(s) *
Home Street Address *
Home City *
Home Zip Code *
Parent(s) E-mail Address *
Parent(s) Cell Phone Number *
Please list any allergies or physical restrictions
Photo Release: Please indicate whether or not you will allow your child's photo to be used in print or internet promotions for Rutherford Bible Chapel, including social media sites like Facebook or Instagram *
Consent To Use Online Platforms *
Consent For Communication With Minor (for teens in 7th to 12th Grades)
Clear selection
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Please check box if you are registering for (please check all that apply)
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms