Student Registration 2021-2022
Thanks for registering your student for Youth Group this year! Please fill out this form for one student only. If you need to submit a form for another student, you will be given the option to do so after hitting the Submit button.
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Student's name *
Student's school & grade level *
Student's phone number
Student's email address
Does this student have any medical (physical or mental) needs which we need to be aware of (allergies, medications, etc.)?
Does the student have an IEP or 504 plan that you would be willing to share so we can work towards consistency in approach between home, school, and church?
Clear selection
If you are filling out this form for an additional student, please feel free to skip the following questions if the answers are the same as the previous student.
Interested in Youth Music (Sundays between upper & lower grades Youth Group)?
Clear selection
Names of parents/guardians *
Parent/Guardian phone number(s) *
Please list the best emergency contact number first
Parent/Guardian email address(es) *
Children's & Adult Faith Formation Options
If you are looking to connect children or adults in your family with any of the following opportunities, check all that may apply and we'll share your info with the appropriate church staff.
Health insurance carrier
Insurance policy number (and group # if applicable)
Policy member's name
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