Bloomfield Congregational Church Sunday School/Youth Group Registration Form

Child's Name

Birth date

Grade

Address

Home Phone

Cell Phone

This address will receive a confirmation email

Mother's Name

Father's Name

Main Contact Person's Name

Main Contact Person's phone number (if not already noted above)

Allergies

Permission

I give permission for photo’s/video to be taken of my child to be used in BCC video, website, or printed materials I do not give permission for photo’s/video to be taken of my child to be used in BCC video, website or printed materials

Electronic Signature

*By entering my name in the box above, I am providing my digital signature on this Form.

Description

Please fill out this form and click submit.

Bloomfield Congregational Church Sunday School/Youth Group Registration Form

Description

Please Fix the Following