First Church Student Ministries Registration

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First Church Student Ministries Registration - 2023/2024 School Year

Please take a few moments to register your student for The Well Student Ministries. If any of the questions do not apply, please write "none" as an answer. You must fill out the entire form for each individual student you have attending.

Student First Name *

Student Last Name *

Student Grade *

6th

7th

8th

9th

10th

11th

12th

Which Ministry are you involved in? *

MSM (Middle School for Stevensville & Saint Joseph Campuses)

HSM (High School for Stevensville & Saint Joseph Campuses)

BHSM (Benton Heights Student Ministries)

ECSM (Eau Claire Student Ministries)

Gender *

Male

Female

Student Email Address *

Student Phone (if none, write none) *

Home Address (House Number and Street only) *

City *

State *

Zip Code *

Parent/Guardian #1 First Name *

Parent/Guardian #1 Last Name *

Parent/Guardian #1 email address *

Parent/Guardian #1 Phone Number *

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Parent/Guardian #2 email address

Parent/Guardian #2 phone number

Student Allergies (if none, write none) *

Student Medical Conditions (if none, write none) *

Student Birthday *

YYYY

Student School *

Saint Joseph

Lakeshore

Benton Harbor

Eau Claire

Coloma

Homeschool

Other

Would you be willing to have a picture added to your registration profile? If yes, please email one to Pastor Adam at adam.r@myfirstchurch.com with "Registration Photo for (student's first & last name)" in the subject line. *

Yes

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