INTERHIGH 2021 Online Registration
*NOTE: Please put the email address that you would like the registration confirmation to go to in the first "Email address" field directly below.
Email *
Student's First Name *
Student's Last Name *
Gender *
Student's Grade in FALL 2021 *
Will the student be attending JEMS Mt. Hermon Family Camp at the Mt. Hermon Conference Center? *
Student's Date of Birth? *
MM
/
DD
/
YYYY
Address (#### Street, City, State, Zip) *
Student Phone # (xxx-xxx-xxxx) - if none, put n/a (to be used by student's leader to communicate with small group via text message to coordinate during week of virtual camp)
Student's Email Address *
Parent / Guardian Name (First & Last) *
Parent / Guardian Phone # (xxx-xxx-xxxx) *
Parent / Guardian Email 1 *
Parent / Guardian Email 2
Do you currently attend church? *
If "yes", church name?
Please describe any allergies that the student has (if none, put n/a). *
Is there anything that you would like for us to know about your child that may help us to better understand his / her needs from a ministry standpoint? (i.e. mental / emotional / social health, significant life events, ADD/ADHD diagnoses, anxiety, etc.) *
Any additional comments or questions?
A copy of your responses will be emailed to the address you provided.
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