Beyond the Bell - FBCS After School Program Student Registration

Please fill out this form and click submit.

Student Information

Name of Child

*

Child's School

*

Please select one option.

Northwest Middle School Mineral Springs Middle Walkertown Middle Gibson Elementary School Rural Hall Elementary

Child's School - if not listed

Child's Grade

*

Please select one option.

4th 5th 6th 7th 8th

Parent / Guardian Information

Name of Parent/Guardian

*

Parent/Guardian Email

*

This address will receive a confirmation email

Parent/Guardian Cell Phone

*

Home Address

*

Administrative Info

If accepted into the program who do you give approval to pick up your child? No more than three (3) names.

*

Upload a photocopy of each person's Government Issued ID

*

Upload (8MB)

Upload a photocopy of each person's Government Issued ID

Upload (8MB)

Upload a photocopy of each person's Government Issued ID

Upload (8MB)

What specific outcomes do you hope to see in your child as they participate in this program? (Examples: growth in spiritual maturity, stronger social skills, academic habits, life skills, deeper understanding of the Bible, etc.)

*

$30 Application Fee (Non-Refundable)

How would you like to pay for your application fee?

*

Please select one option.

Cash Check Credit Card

If paying by credit card, enter $30 in to the

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.

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