BCCC Youth Ministry Master Registration Form
This is a form that needs to be filled out one time per student which allows us to speed up the registration process for future events!
* Required
Email address
*
Your email
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Current Grade
*
6th
7th
8th
9th
10th
11th
12th
Current School
*
Your answer
Parent/Guardian #1 Name
*
Your answer
Parent/Guardian #1 Cell Phone Number
*
Your answer
Parent/Guardian #2 Name
Your answer
Parent/Guardian #2 Cell Phone Number
Your answer
Emergency Contact Name (Not a Parent)
*
Your answer
Emergency Contact Cell Number (Not a Parent)
*
Your answer
Home Address
*
Your answer
By checking this box you are giving your child permission to attend Youth Ministry at Bucks County Community Church.
*
Yes
No
I do/do not give permission for my child's photo to be used to promote events and activities at BCCC.
*
Do
Do Not
Please List Any Allergies:
Your answer
Electronic Signature: You are stating as the parent/guardian that the above information is accurate.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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