2017 Fall Disciple Group Registration
Please use this form to register for our Fall 2017 disciple groups. Some groups have a materials fee that can be paid the first night of the group! Contact Chris at (734) 455-5910 x 111 or cleach@sjncanton.org with questions!
Participant First Name *
Your answer
Participant Last Name *
Your answer
Participant Date of Birth *
MM/DD/YYYY
Your answer
Grade in School *
All participants must be in grades 9-12.
Street Address *
ex. 44800 Warren Road
Your answer
City Address *
ex. Canton
Your answer
Zip Code *
Your answer
Participant Phone Number *
ex. 734-455-5910
Your answer
Does the participant receive text messages? *
Participant E-Mail Address *
Your answer
Parent Name(s) *
ex. Larry and Barbara
Your answer
Parent Phone Number *
ex. 734-455-5910
Your answer
Does the parent receive text messages? *
Parent E-Mail Address *
Your answer
Which group would you like to register for? *
Please check as many as you would like.
Required
Parents-- would you like someone to contact you about the similar discipleship group opportunities for adults taking place at St. John Neumann? *
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