Student Registration

First Name*
Last Name*
Birthdate

mm/dd/yyyy
Parent Name Prefix*
Parent First Name*
Parent Last Name*
Second Parent Name Prefix
Second Parent First Name
Second Parent Last Name
Email*
Email Type*
Home Phone

xxx-xxx-xxxx
Mobile Phone*

xxx-xxx-xxxx
Work Phone

xxx-xxx-xxxx
Other Phone

xxx-xxx-xxxx
Preferred Phone*
Address*
City*
State*
Zip*
Country*
Comment
How often do you attend church?*
Church Name
School District*
School Name*
Grade*
Teacher*
Year Attending

Choose the year you wish to register for.
Does your child have any allergies or medical conditions that we should be aware of?
Emergency Contact First Name*
Emergency Contact Last Name*
Emergency Contact Phone*

xxx-xxx-xxxx
Please check here if your child cannot be included in pictures and videos used to promote Bible2School
Please check here if above information may not be shared with Bible2School partners
1. I give permission for my child to participate in the Bible2School Program in his/her school. I hereby request my child (named on the form above) to be excused from his/her public school class each week for instruction in the Bible Elective by Bible2School.
2. I understand my child will be walked or transported to the place of instruction by the Bible2School team.
3. Bible2School's volunteer staff will serve in loco parentis for me to attest to my child's attendance at the Bible Electives.
4. I understand that my child may be removed at any point from Bible2School upon written notice from the parent/guardian and likewise Bible2School has the right to remove any student from the program for disciplinary issues.
5. Bible2School will in no way be responsible for medical treatment or liability resulting from physical conditions existing prior to my child attending our Bible Elective.
6. I give permission to Bible2School to act on my behalf in my child's best interest in the event of an accident or emergency. I give my permission to the hospital and/or doctor to treat or operate on my child in the event that I cannot be reached.
I agree to the statements outlined above*