Year Attending
Choose the year you wish to register for.
2023/24
Name
First
Last
Birthdate
MM slash DD slash YYYY
School Information
School District
School Name
Grade
Teacher
Parent Name
Mr.
Ms.
Mrs.
Dr.
Prof.
Pastor
Prefix
First
Last
Second Parent Name
Mr.
Ms.
Mrs.
Dr.
Prof.
Pastor
Prefix
First
Last
Email
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State / Province
ZIP Code
Mobile Phone
Home Phone
Work Phone
Preferred Phone
Mobile
Home
Work
Emergency Contact
First
Last
Emergency Phone
Church Name
How often do you attend church?
Regularly
Occasionally
Holidays
Do not attend church
Does your child have any allergies or medical conditions that we should be aware of?
No Photos
Please check here if your child cannot be included in pictures and videos used to promote @@Bible2School@@
DO NOT SHARE INFO
Please check here if above information cannot be shared with @@Bible2School@@ partners
Text Opt In
Yes, please send me occasional text messages.
Bible2School may text a few times a year to keep you in the loop on great resources! Your carrier texting fees may apply.
Parent Consent
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@@.
I understand my child will be walked or transported to the place of instruction by the @@Bible2School@@ team.
@@Bible2School@@'s volunteer staff will serve in loco parentis for me to attest to my child's attendance at the Bible Electives.
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.
@@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.
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
URL
This field is for validation purposes and should be left unchanged.
Δ