Encounter Jr/Sr High 2018 Registration
Fill out the form below to register for Encounter Jr/Sr High student ministry at River Valley Church for the 2018-2019 school year. Please fill out one form for each student, so we can keep their information separated. Thanks!
Student's Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Age *
Your answer
Grade This School Year *
Your answer
Parent's Name *
Your answer
Address *
Your answer
Student Phone number *
Your answer
Student Email
Your answer
Student's preferred contact method *
Parent Name(s) *
Your answer
Parent Phone number(s) *
Your answer
Parent Email
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Special Needs/Allergies/Helpful Information *
Your answer
Church Affiliation (if none, please indicate below) *
Your answer
Active At Affiliated Church? *
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