Student First Name:
Student Last Name:
Student Email:
Student Cell Phone:
Student Birthdate:
Are you on facebook?:
School Name:
High School graduation year:
How do you best communicate (check one or more):
Email
Text
Phone call
facebook
Parent #1 First Name:
Parent #1 Last Name:
Parent #1 Email:
Parent #1 Phone:
Parent #1 Address:
How do you best communicate (check one or more):
Email
Phone call
Paper
Web
Parent #2 First Name:
Parent #2 Last Name:
Parent #2 Email:
Parent #2 Phone:
Parent #2 Address:
How do you best communicate (check one or more):
Email
Phone call
Paper
Web
Ministry Assistance (check all that apply):
I can transport students to events
I can provide food for events
I am willing to host an event at my home
I can loan my vehicle to youth ministry
I am willing to help chaperone a youth event/retreat
I can provide access to a home/lodge/cabin for daytime use
I can provide access to a home/lodge/cabin for overnight or multi-night use
If you can provide transportation, please indicate how many your vehicle seats:
If you can provide access to a home/lodge/cabin, please indicate how many it can accommodate:
Comments:
Verify:
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