BUS RIDER REGISTRATION

Parent's First Name
Parent's Last Name

Address
City
State
ZIP

Email Address 

 Phone #

 

NOTE: Please enter the grade the child is currently in.  Also, no child is allowed to ride who is NOT                    potty-trained.
INFORMATION:  All children must be dropped off where they are picked up.
 

 CHILD'S NAME(First & Last)
    AGE                GRADE            DATE OF BIRTH
  MONTH        DAY        YEAR
      SEX OF CHILD
    MALE   /  FEMALE


                          


       
                  

  

    

                  


  

     

                    

  

     

                  

  

     

                  

  

     

                 

  

     

                  
 
        
                   
 
                           
 



Tabernacle Baptist Church  |  115 West 11th Street, Roswell, NM 88201   |   (575) 622-7912   |   Powered by Divine Design

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