FPC Student Ministries Registration Form
Full Name
ex: Adam C. Bowling
Your answer
I wish to be called (nickname)
ex: "Sam" for Samantha or Samuel
Your answer
"Snail Mail" Address
Street, City, State, and Zip Code
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Grade in 2016-2017
Student’s Cell Phone
ex: (828) 448-8914
Your answer
Now text "@66ac0" to 81010 to be added to the FPCYouth text reminder service!
Facebook Name
ex: "Adam Christopher Bowling" or "https://www.facebook.com/revabowling"
Your answer
Twitter Username
ex: @PCUSAPastorAdam
Your answer
Instagram Username
ex: @PCUSAPastorAdam
Your answer
Would You like to receive an FPC Newsletter?
Primary student e-mail address
Your answer
Secondary student e-mail address
Your answer
School attending this year
ex: "Draughn High School" or "Liberty Middle School"
Your answer
Student T-shirt size
The best way to send me FPC Student Ministries Info is...
I am interested in attending the High School or Middle School Mission Trip next Summer
I can play an musical Instrument...I play
ex: "trumpet"
Your answer
Please choose at least three (3) ways to share your gifts!
Home Phone
ex: 828-448-8914
Your answer
(1) Parent or Guardian’s Name
ex: "Patricia Bowling"
Your answer
(1) Parent or Guardian's Cell Phone
ex: 828-448-8914
Your answer
(1) Parent or Guardian's Home Phone
ex: 828-437-1811
Your answer
(1) Parent or Guardian's Work Phone
ex: 828-437-1811
Your answer
(1) Parent or Guardian's Address
Street, City, State, and Zip Code
Your answer
(1) Parent or Guardian's Primary e-mail address
Your answer
(2) Parent or Guardian's Name:
Your answer
(2) Parent or Guardian's Cell Phone
ex: 828-437-1811
Your answer
(2) Parent or Guardian's Home Phone
ex: 828-437-1811
Your answer
(2) Parent or Guardian's Work Phone
ex: 828-437-1811
Your answer
(2) Parent or Guardian's Address
Street, City, State, and Zip Code
Your answer
(2) Parent or Guardian's Primary e-mail address
Your answer
I/We “Parental Units” Can Help by:
By clicking "Submit" I agree to abide by the First Presbyterian Student Ministries Covenant posted in the Youth Lounge. I ALSO PLEDGE TO BE RESPECTFUL OF OTHERS AND STAND UP AGAINST BULLYING WHENEVER & WHEREVER I SEE IT.
Submit
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