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Beech Combers Registration
Please complete the form in its entirety in order to register your child for BSBC's Wednesday night programing.
* Indicates required question
Email
*
Record my email address with my response
Parent's Name(s)
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Children's Names and Ages/Grade Levels
*
Your answer
Do any of your children have any food allergies?
*
Yes
No
If you answered yes, please provide the name of the child (children) and the allergy.
Your answer
Will you be dropping off/picking up your child (children) or will they be catching a ride on the church van.
*
Picking Up/Dropping Off
Church Van
Emergency Contact (if not listed above)
Your answer
Will any other person be picking up your child? If so, please provide their name here.
Your answer
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