RTC/GNC/Zoom Registration Form

RTC/GNC/Zoom Class Student Registration Form

Fill out the form carefully for registration
Which option would you like to sign up for?

Zoom Released Time (during school time) In-Person Released Time (during school time) Zoom Good News Club (after school) In-Person Good News Club (afterschool) Wednesday Zoom Class (afterschool) Friday Zoom Class (afterschool)

attending students #
How many students are attending?

section stopper #1

Student #1
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Age *
Attending School *
Is the student currently doing school Online or In-Person *

Online In-Person
What grade is the student currently in?

stopper #2

Student #2
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Age *
Attending School *
Is the student currently doing school Online or In-Person *

Online In-Person
What grade is the student currently in?

stopper #3

Student #3
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Age *
Attending School *
Is the student currently doing school Online or In-Person *

Online In-Person
What grade is the student currently in?

Stopper #4

Student #4
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Age *
Attending School *
Is the student currently doing school Online or In-Person *

Online In-Person
What grade is the student currently in?

stopper #5

Student #5
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Age *
Attending School *
Is the student currently doing school Online or In-Person *

Online In-Person
What grade is the student currently in?

stopper#6

Student #6
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Age *
Attending School *
Is the student currently doing school Online or In-Person *

Online In-Person
What grade is the student currently in?

stopper #7

Student #7
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Age *
Attending School *
Is the student currently doing school Online or In-Person *

Online In-Person
What grade is the student currently in?

stopper #8

Parent Info
Parent/ Guardian Full Name *

First Name Last Name
Relationship to student(s) *
Parent/Guardian Full Name

First Name Last Name
Relationship to student(s)
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent E-mail
example@example.com
Mobile Number *
Home Number
Emergency Number *
Church you attend
Check if none

None
Should be Empty:

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