Event Registration

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Middle School 2022/23 Registration on Wednesday, September 7, 2022 @ 6:30 PM

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*Date of Birth:
*Gender:
*School:
*Grade:
:
What church does your family regularly attend?:
*Parent/Guardian Name:
*Parent/Guardian Phone Number:
:
*Parent/Guardian Email Address:
:
Please list any allergies your student may have here.:
PARENT/GUARDIAN: I hereby consent to any medical treatment deemed necessary during my child's participation in Student Ministries. I assume the risk and financial responsibility for any injury, illness or liability resulting from my child's participation.:
*Medical Release Consent - Your Name Please:
PARENT/GUARDIAN: I hereby consent to photos taken during Student Ministry events and Student Ministry activities necessary to share for promotional and\or in memory of Student Ministries for my child either in a group setting or close up. :
*Photo Consent: