RTC & GNC Registration Form

RTC or GNC Student Registration Form

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

Released Time ClassAfterschool Good News Club

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*
Teacher's Name
Is the student currently doing school Online or In-Person*

OnlineIn-Person
What grade is the student currently in?
Medications or Food Allergies*

stopper #2

Student #2
Student Name*

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Age*
Attending School*
Teacher's Name
What grade is the student currently in?
Is the student currently doing school Online or In-Person*

OnlineIn-Person
Medications or Food Allergies*

stopper #3

Student #3
Student Name*

First Name Middle Name Last Name
Birth Date

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

OnlineIn-Person
What grade is the student currently in?
Medications or Food Allergies*

Stopper #4

Student #4
Student Name*

First Name Middle Name Last Name
Birth Date

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

OnlineIn-Person
What grade is the student currently in?
Medications or Food Allergies*

stopper #5

Student #5
Student Name*

First Name Middle Name Last Name
Birth Date

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

OnlineIn-Person
What grade is the student currently in?
Medications or Food Allergies*

stopper#6

Student #6
Student Name*

First Name Middle Name Last Name
Birth Date

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

OnlineIn-Person
What grade is the student currently in?
Medications or Food Allergies*

stopper #7

Student #7
Student Name*

First Name Middle Name Last Name
Birth Date

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

OnlineIn-Person
What grade is the student currently in?
Medications or Food Allergies*

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
If you do not attend a church, please select None.

Now create your own Jotform - It's free!Create your own Jotform