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2023-2024 Student Registration
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Email
*
Your email
First Name of Student
Your answer
Last Name of Student
Your answer
Gender
Male
Female
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Address
Your answer
City
Your answer
Date of Birth
Your answer
Grade (Beginning in August 2023)
Infant
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
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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
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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
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Berlin Christian Church Has Permission to Transport Child
Yes
No
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Please List Other People Who Have Permission to Transport and Check-Out Child
Your answer
Has Student Been Immersed?
Yes
No
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Berlin Christian Church Has Permission to Photograph Child
Yes
No
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This Form Was Filled Out For (choose all that may apply)
JAM & Encore (Children's Church & Sunday School)
God Squad (Wednesday Nights Pre-K-5th Grade)
Youth Group (Wednesday Nights 6th-12th Grade)
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.
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Name of Person Signing
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