2025-2026 Student Registration
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Email *
First Name of Student
Last Name of Student
Gender 
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Address
City
Date of Birth 
Grade (Beginning in August 2025)
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Name of Parent/Guardian(s)
Parent/Guardian(s) Cell Phone Number (Please specify which parent)
I would like to be added to the BCC texting service for Youth Group updates:
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Student Cell Phone Number
Allergies (Write N/A if none)
List Any Special Needs, Medications, and/or Medical Concerns for Child (Write N/A if none)
Does Your Child Need Transportation?
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Berlin Christian Church Has Permission to Transport Child
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Please List Other People Who Have Permission to Transport and Check-Out Child
Has Student Been Immersed?
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Berlin Christian Church Has Permission to Photograph Child
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This Form Was Filled Out For (choose all that may apply)
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.
Name of Person Signing
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