Student and Family Ministry Participant Information Form

Parent/Grandparent Name

Last Name

Parent/Grandparent Email

Parent/Grandparent Phone

Number of Students

Student First Name

Last Name

Student Birthdate

Student Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Student School

Student Grade

Student Hobbies (Including sports teams)

Student Allergies/Dietary Needs

Permission to be Driven in the Church Van

Church vans will be driven by church staff or volunteers over the age of 25 who are on the church's insurance.

Any info we need to know (Confidential)

Emergency Contact Name

Last Name

Emergency Contact Phone

Preferred Mode of Communication (Email/Text/GroupMe)