HSE / FISHERS CAPERNAUM
Please register your student below. This information is confidential and used only to allow us to serve your student as best as possible.

If you have any questions or concerns, please don't hesitate to contact Ian Faulkner, the HSE YL, WyldLife, and Capernaum Area Director at 765.490.1101 or ijfaulkner@gmail.com

Student First Name *
Your answer
Student Last Name *
Your answer
Age *
Your answer
Gender *
Parent Name *
Your answer
Parent E-mail *
Your answer
Parent Cell Phone *
Your answer
Help us get to know your student
We are excited about every student who joins us, be it for a Young Life, WyldLife, or Capernaum event. We recognize that we aren't experts when it comes to your students and what is best for them each individually. Because we often provide food, play a variety of games, and seek to add elements of adventure to our programing, would you please complete the section below to help us know how we can best serve your student.
Allergies
Your answer
Foods to avoid?
Your answer
Activities that might best serve your student?
Your answer
Activities that might be harmful or should be avoided for your student?
Your answer
Anything else about your student that you would like for us to know as they join us for Capernaum this year?
Your answer
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