PULSE 2018 - 2019 Registration
First Southern Baptist Church of Mattoon
3521 DeWitt Ave, Mattoon IL, 62938
Office Phone:
(217) 234-8314
Mike Sloan (Youth Pastor):
(217) 232-0390
Students Name *
Your answer
Students Birthday *
Students Gender *
Students Address *
Your answer
School *
Your answer
Current Grade *
Your answer
Information about Youth Group events will often be done by Text/E-mail
Students Phone #
Your answer
Students E-mail
Your answer
Is it ok to text student? *
Parent/Guardian Name *
Your answer
Parent/Guardian Address *
Your answer
Parent/Guardian Cell Phone Number *
Your answer
Parent/Guardian E-mail address *
Your answer
Photo Release
Pulse Youth Group has a Facebook Page and Website where photos and videos from Pulse events are periodically published. We also have a youth bulletin board where we sometimes post photos from events. It is FSBC's policy that photos of children are never published with names or other identifying information
I herby grant First Southern Baptist Church of Mattoon, also referred to as FSBC of Mattoon, the permission to use my students likeness photographs, videos, and other media in any and all of it's publications, including bulletin boards and website entries. I wave the right to royalties and other compensation arising or related to the use of the photographs or videos *
A covenant is an agreement in partnership with God between members of a community. as a student in Pulse Youth Group activities, events, and trips. I covenant to embody PULSE/FSBC. I covenant to be open minded, flexible, and compassionate, showing respect for other people, their bodies, their property, their cultures, and their beliefs. I also covenant to listen to directions, to be mindful of safety and to abstain from any behavior that harms or endangers myself, others, or the health of the group. including but not limited to bullying, sexual activity, harassment, violence, negativity, intense displays of affection, and possession or use of tobacco, alcohol, or drugs not prescribed to me. I covenant to speak up about my own needs and to speak to an adult immediately if I feel unsafe or if I witness breaches of covenant. I understand that when we keep our covenant promises teach other, we co-create with God a safe, life-giving environment in which we are all lifted up. when we break covenant with each other, we break trust and disrupt our ability to operate as a safe and loving community. I understand that should I decide to break this covenant, I may be asked by adult leaders to leave the activity or event. At the discretion of the Youth Pastor and/or the adult leaders.
Signature of Student *
Your answer
Signature of Parent/Guardian *
Your answer
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