Student Information Form

Student Information

Student's Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Student's Cell Phone *

Can we text?

Yes
No

Birthday *

Current Grade *

T-Shirt Size *

Gender *

School *

Parent/Guardian Name *

First

Last

Parent's Cell Phone *

Parent's Email *

I came with a friend *

Yes
No

Please check all that apply:

I am a first time Sunday visitor
Please add me to a Small Group roll
I am a first time Wednesday Night visitor
Please add me to the Wednesday Night student roll