First Church Student Ministries Registration - 2021/2022 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.
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Student First Name *
Student Last Name *
Student Grade *
Gender *
Student Email Address *
Student Phone (if none, write none) *
Home Address (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 *
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Student School *
 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. *
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