To pre-register your student please complete the form. One form per student.

Last Name	*
First Name	*
Please choose only 1-- On-Line or Backyard
On-Line Bible School		Yes No
Backyard Bible School		Yes No
Student's Birth Date	*
Last Grade Completed	*
Mailing Address	*
City, State, Zip Code	*
Home Phone
Cell Phone
Emergency Phone	*
Email	*
Parent's or Guardian's Name	*
Allergies or Medical Information
Does the Student Regularly Attend Church?		Yes No
If Yes, Name of Church
Names of Brothers and Sisters
Permission to use pictures of my child on church website		Yes No
Other Comments
Security Code	*