Student Ministry Registration 2016/17

This registration form is necessary for making sure we have all the necessary contact information on students who are part of the ministry regardless of the frequency of participation.  Simply complete the form below and you will also then be added to our weekly email regarding upcoming events, activities and other information regarding students.  

This registration is for the ministry year, but is NOT an EVENT REGISTRATION.  Those forms are found in the info pages for specific events.

Primary Parent Name *
Primary Parent Name
Primary Parent Address *
Primary Parent Address
Primary Parent Cell Phone *
Primary Parent Cell Phone
Home Phone (optional)
Home Phone (optional)
Additional Parent Name
Additional Parent Name
Additional Parent Cell Phone
Additional Parent Cell Phone
Additional Parent Address (if different from above)
Additional Parent Address (if different from above)
Would you be willing to serve in this ministry? *
Check all that may interest you
Student # 1 Information
Name of Student #1 *
Name of Student #1
Gender *
Date of Birth *
Date of Birth
Cell Phone
Cell Phone
Student #2
Name of Student #2
Name of Student #2
Gender
Date of Birth
Date of Birth
Student Cell
Student Cell
Student # 3
Name of Student #3
Name of Student #3
Gender
Date of Birth
Date of Birth
Student Cell
Student Cell
Student # 4
Name of Student #4
Name of Student #4
Gender
Date of Birth
Date of Birth
Student Cell
Student Cell