MBC Child/Student Questionnaire

Please fill out one form* for each child in your family. All information is for staff use only.

*Form answers will be valid from now through August 30 of next year to align with the school year.

Your name *

Email address *

Phone number *

Child's Personal Information

All information is for staff purposes only.

Registered Child's Name *

Which group is your child in? *

Which school does your child attend? *

City of Residence *

Does your child have any allergies or concerns we should be aware of? *

Please state as much info as necessary to help us understand your child's needs. (Epi-Pen, allergies, asthma, medications, etc.)

Household Information

Please list other family members of your child. *

This is meant to help our staff identify family members of the child.

Parents/Guardians: Name (first/last), email address, phone number, relationship to child
Siblings: Name (first/last), Grade (or age if not in school)

Does your family regularly attend church? *

Please share a photo of your family.

The purpose of this photo is for our staff binder only, and is meant to help our staff identify family members of the children.

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