Encounter Jr/Sr Ministry 2023-2024 Registration

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Please fill out the form below to register for Encounter Jr/Sr High students ministry at River Valley Church for the 2023-2024 school year. Please fill out one form for each student, so we can keep their information separated. Please be sure to review and sign the release statement at the bottom of the form. Thanks!

Student's Name *

Birth Date *

YYYY

Age *

Grade This Year *

Parent's Name *

Address *

Student Phone number *

Do You Text? *

Yes

Emergency Contact Name *

Emergency Contact Phone Number *

Special Needs/Allergies/Helpful Information *

Church You Attend (if none, please indicate below) *

Photo & Video Release Statement

The undersigned parent or legal guardian grants permission for the said child’s pictures to be taken at youth group and/or River Valley Church of Christ's sponsored events on or outside of church property, which can be used on the church website (www.rivervalley.live), social media accounts, and promotional materials.

Sign By Typing Your Name Below *

Submit

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