"
*
" indicates required fields
Name
*
First
Last
Birthdate
MM slash DD slash YYYY
Parent Name
*
Mr.
Ms.
Mrs.
Dr.
Prof.
Pastor
Prefix
First
Last
Second Parent Name
Mr.
Ms.
Mrs.
Dr.
Prof.
Pastor
Prefix
First
Last
Email
*
Email Type
*
Personal
Work
Alternate
Mobile Phone
*
Work Phone
Home Phone
Other Phone
Preferred Phone
*
Mobile
Work
Household
Other
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
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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
Comment
How often do you attend church?
*
Regularly
Occasionally
Holidays
Do not attend church
Church Name
School District
*
Select a District
Cornwall Lebanon
School Name
*
Select a School
South Lebanon
Grade
*
Select a Grade
Grade 4
Teacher
*
Year Attending
Choose the year you wish to register for.
2022/23
Does your child have any allergies or medical conditions that we should be aware of?
Emergency Contact
*
First
Last
Emergency Phone
*
No Photos
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DO NOT SHARE INFO
Please check here if above information may not be shared with Bible2School partners
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
Email
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