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2022-2023 Student & Child Registration
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* Indicates required question
Email
*
Your email
First Name of Student
*
Your answer
Last Name of Student
*
Your answer
Gender
*
Female
Male
Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade (beginning in August 2022)
*
Choose
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
College
Name of Parent/Guardian(s)
*
Your answer
Parent/Guardian(s) Cell Phone Number (Please specify which parent)
*
Your answer
I would like to be added to the BCC texting service for God Squad or Youth Group updates:
*
Yes
No
Student Cell Phone Number
Your answer
Allergies (Write N/A if none)
*
Your answer
List Any Special Needs, Medications, and/or Medical Concerns for Child (Write N/A if none)
*
Your answer
Does Your Child Need Transportation?
*
Yes
No
Berlin Christian Church Has Permission to Transport Child
*
Yes
No
Please List Other People Who Have Permission to Transport and Check-Out Child
Your answer
Has Student Been Immersed?
Yes
No
Clear selection
Berlin Christian Church Has Permission to Photograph Child
*
Yes
No
This Form Was Filled Out For (choose all that may apply)
*
Sunday Night Youth Group (6th-12th Grade)
God Squad (Wednesday Night Programming: Pre-K-5th Grade)
J.A.M. (Sunday School)
Infant Encore (Nursery during church)
Toddler Encore (Pre-K through Kindergarten)
Elementary Encore (K-5th Grade)
Required
By entering your name in the box below, you are indicating that you are 18 years or older, and that all the information on this form is true and accurate, to the best of your knowledge.
*
Yes
Required
Name of Person Signing
*
Your answer
Submit
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