CEPC Student Ministries Registration
Hey There! Thanks for checking out Student Ministries at Christ Evangelical Presbyterian Church! The form below is the fastest way to get yourself (or your child) onto our roster.

This allows us to contact you if needed, send you regular announcement emails, and helps us to make sure we pray for each student regularly!

If you'd rather fill out a paper information sheet, this same questionnaire is available in The Barn during any of our regular programming times.

If you have any questions, please don't hesitate to contact Patrick Fischl, our Student Ministries Director, at patrick@cepc.org.

Thanks again for filling this out!

Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Gender *
Student's Date of Birth *
MM
/
DD
/
YYYY
Current grade in school *
(If filling out during the summer months, enter grade they'll be attending when school starts)
Student's school *
Your answer
Student cell phone (if applicable)
Your answer
Student Email Address (if applicable)
Your answer
Student's home address *
Your answer
Parent's names *
Your answer
Mom's Cell Phone
Your answer
Dad's Cell Phone
Your answer
Home phone (if applicable)
Your answer
Mom's email address
Your answer
Dad's email address
Your answer
Does the student have any food allergies? If so, please list below.
We will often serve food at student ministry events. Although we cannot accommodate every special diet, we do take extra effort to having something for everyone. If an allergy is particularly troubling (eg. they can't even be around peanuts), please indicate that below.
Your answer
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