JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Level 52 Registration Form
Level 52 is the 4th - 5th grade fellowship group associated with the Bay Area Chinese Bible Church (BACBC).
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Male
Female
Clear selection
Grade
4th Grade
5th Grade
Other:
Clear selection
School
Your answer
Address
Your answer
Parent name (1)
Your answer
Parent phone number (1)
Your answer
Parent email (1)
Your answer
Parent name (2)
Your answer
Parent phone number (2)
Your answer
Parent email 2)
Your answer
Special Dietary Needs/Food Allergies
Your answer
Medical Needs
Your answer
Medical Insurance Name and Policy Number (Optional)
Your answer
Authorization for Minor Child Release:
Besides parents/guardians, the following people are authorized to pick up my child (They may be called in case of emergency if parents cannot be reached).
Name, Relationship and Contact number (1)
Your answer
Name, Relationship and Contact number (2)
Your answer
Name, Relationship and Contact number (3)
Your answer
Name, Relationship and Contact number (4)
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Bay Area Chinese Bible Church.
Report Abuse
Forms
