First United Church of Christ Child and Youth Ministry Registration for 2022-23
Includes:  Sunday School, Middle School Youth (MSY), Confirmation and High School Fellowship
Sunday School (3 yo - 5th Grade) to be held Sunday Mornings, 9:15 - 10:30 am  (Sundays excluding 1st Sundays in the month)
Middle School Youth (MSY) (6th - 8th Grade) - Wednesday evenings, 6:00 - 7:00 pm
Confirmation (9th Grade) - Wednesday evenings, 7:00 - 8:00 pm
High School Fellowship (9th - 12th Grade) - More details to follow

Where: 130 E. Church St., Belleville WI  53508

MSY/Confirmation Note:  Due to the times of these classes participants can bring in a snack/meal if necessary.

Questions??  Contact us at (608) 424-3572 or office@bellevillefirstucc.org

Please complete and submit this form, including all children and youth in your household.

Thank you.      

Sign in to Google to save your progress. Learn more
Email *
Child/Youth's Name *
Date of Birth *
MM
/
DD
/
YYYY
Grade *
Child/Youth's Name (2)
Date of Birth
MM
/
DD
/
YYYY
Grade
Child/Youth's Name (3)
Date of Birth
MM
/
DD
/
YYYY
Grade
Child/Youth's Name (4)
Date of Birth
MM
/
DD
/
YYYY
Grade
Parent/Guardian's Name *
Parent/Guardian contact phone number *
Emergency Contact if you are not accessible (Name/Contact Number) *
Primary Physician (Name/Contact Number) *
Insurance Carrier & Policy Number *
Where does your child(ren) attend school? *
Special needs, learning styles and/or accommodations?
Allergies? If registering multiple children please be sure to specify the child with the allergy. *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Belleville First United Church of Christ.

Does this form look suspicious? Report

Google Forms