STUDENT REGISTRATION AND INSURANCE FORM
PARENTS: Please fill out the following paperwork for your MSM or HSM student. Once submitted, your student has been registered. Please note, if you have more then one student in MSM or HSM ministry you must fill out this form again with each students information.
Student’s Information
First Name *
Your answer
Last Name *
Your answer
Male or Female *
Cell Phone
Your answer
Email Address *
Your answer
Birthday *
MM
/
DD
/
YYYY
Age *
Your answer
Grade *
Your answer
Would your student like to receive text updates about upcoming events? *
School *
Required
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
State *
Church Affiliation (If applicable)
Friend that brought you
Your answer
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