22:SIX Youth Ministry @ Faith Family Church
Welcome to our online enrollment for 22:SIX Ministry at Faith Family Church! We are excited about the big changes happening with our ministry, and our church family, and we are happy to have your child and your family taking part!

Please complete this enrollment form for EACH child/student you have participating in our youth program.

22:SIX Ministry is derived from Proverbs 22:6 - "Start children off on the way they should go, and even when they are old they will not turn from it". Our youth ministry will be purposeful, active, engaging, and spiritual.

The church is located at 508 W Green St, Frankfort, IN 46041. The youth house and garage is behind the main church building.

Please complete this online enrollment to register your student. This ministry is open to all students in grades 6-12, regardless of the school they attend. For the purposes of this form the term "student" refers to the child you are legally able to register.

(Each youth ministry adult leader has a background check completed before leading our youth in any capacity.)

Thank you!

Jerrad Blacker
22:SIX Ministry
Faith Family Church

*IF YOU HAVE ANY QUESTIONS CALL JERRAD AT 765-601-3190*

Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Birthday *
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Student's Grade *
Student's Email Address
Your answer
Student's Street Address *
Your answer
Student's City/Town *
Your answer
Student's (CELL) Phone number
Your answer
Student's School *
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Parent's Email Address *
Your answer
Parent's Street Address *
Your answer
Parent's City/Town *
Your answer
Parent's (CELL) Phone number *
Your answer
Contact #1 First Name *
Your answer
Contact #1 Last Name *
Your answer
Contact #1 Email Address
Your answer
Contact #1 Street Address *
Your answer
Contact #1 City/Town *
Your answer
Contact #1 (CELL) Phone number *
Your answer
Contact #1 Relationship to Youth *
Contact #2 First Name *
Your answer
Contact #2 Last Name *
Your answer
Contact #2 Email Address
Your answer
Contact #2 Street Address *
Your answer
Contact #2 City/Town *
Your answer
Contact #2 (CELL) Phone number *
Your answer
Contact #2 Relationship to Youth *
Guidelines Agreements *
By checking the I agree box, I agree if a discipline problem is deemed serious enough, the youth will be sent home at the parent’s expense.
Required
Guidelines Agreements *
By checking the I agree box, I agree I have read and agree to these guidelines for my child. I also agree I have informed my child of these guidelines, and they agree to follow them as well.
Required
Medical Insurance Company Name *
Your answer
Medical Insurance Policy Holder Name *
Your answer
Medical Insurance Policy Number *
Your answer
Does your student experience any of the following? *
If you check a box or need to add something not on the list, please check the "other" box to explain further.
Required
Does your student have an allergic reaction to any of the following: *
If you check a box or need to add something not on the list, please check the "other" box to explain further.
Required
Does your student have any condition that would prevent him/her in participating in any activities? *
If yes, check yes, and also check the "other" box to explain.
Required
Does your student take any medications? *
If yes, check yes, and also check the "other" box to explain.
Required
Does your student have any sight or hearing impairment? *
If yes, check yes, and also check the "other" box to explain.
Required
Has your student been diagnosed with any mental health condition? *
If yes, check yes, and also check the "other" box to explain.
Required
Please list any information not covered by the previous questions, or information you would like to add.
Your answer
Medical Section Digital Signature *
By checking the I agree box below, I confirm that all the information listed on the medical section of this form is truthful and accurate. I understand that the youth ministry is concerned about the health and safety of my child and will follow the guidelines of this form in concerns to my child. I understand that neither the Faith Family 22:SIX Youth Ministry, nor does Faith Family Church accept any responsibility in the event that my child gets hurt or sick.
Required
Medical Release - Required *
By checking the I agree box below, I hereby release Faith Family 22:SIX Youth Ministry, as well as Faith Family Church from responsibility and liability for any illness or injury that my child may sustain during activities held during any and all youth/church functions. In the event of an emergency, I hereby authorize an adult leader of Faith Family 22:SIX Youth Ministry, as well as Faith Family Church, to act as agent for me, to consent to any x‐ray examination, medical, dental, or surgical diagnosis, treatment, and hospital care advised and supervised by a physician, surgeon, dentist (as appropriate), licensed to practice under the laws of the state where services are rendered, either at a doctor’s office or in any hospital. I expect to be contacted as soon as possible.
Required
Permission To Participate *
By checking the I agree box below, I give permission for my child to join the Faith Family 22:SIX Youth Ministry, a ministry of Faith Family Church, Frankfort, IN, in any of the physical or off-campus activities or trips sponsored by the ministry, the church, its staff and sponsors. If for some reason you do not wish for your child to participate in activities, then please check the box for "I don't agree" and provide information to staff directly.
Permission To Transport *
By checking the I agree box below, I give permission for my child to be transported by any Faith Family 22:SIX Youth Ministry, and Faith Family Church members, in any of the activities or trips sponsored by the ministry, the church, its staff and sponsors, and in no way hold them responsible, or liable, in the event of accident or injury to my child. If you check the box "I don't agree" then you will be responsible for transporting your child to youth events.
Social Media Waiver *
By checking the I agree box below, I understand that my child may be photographed or recorded on video during the course of youth ministry events, and their image may be used in social media sites administered by the Faith Family 22:SIX Youth Ministry, and Faith Family Church, as well as in print, electronic, or video form for the promotional purpose of future retreats and youth group activities. By checking the I agree box below, I understand if I do not wish for my child's image to be reflected on any social media or promotional purposes, then it is my responsibility to inform the staff of my wishes.
Required
Fun, Food and Faith Waiver *
By checking the I agree box below, I agree that I want my child to have fun, have some grub and to grow in their faith!
Required
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