Parent info form

Parent / Guardian #1

First Name

Last Name

Email

Phone

(###)

###

####

Address

I would like more information on volunteering to help youth.

Yes

No

Media Release

We are always snapping photos and videos at our services and events. Our kids love to see the memories of things we do together and they love to see themselves in a cool video we made! We do occasionally use our photos and videos for promotion inside our church as well as on social media and our website. Please check the box below if you are NOT comfortable with your child being on camera.

I am comfortable with my child being photographed.

I am NOT comfortable with my child being photographed.

Is there anything else we should know?

We want to serve your family in the best way we can. If you can tell us anything specific about your family or child's struggles, it helps us serve them better!

Parent / Guardian #2

First Name

Last Name

Email 2

Phone 2

(###)

###

####

Address 2

I would like more information on volunteering to help youth.

Yes

No

student info form

*If you have more than one student, fill out the form multiple times!

Name

First Name

Last Name

Birth Date

MM

DD

YYYY

Grade

School

Email

Phone

(###)

###

####

Allergies?

Anything Else We Should Know?

Anything that will help us serve your student better!

Thank you for filling this form out!

Once you hit Submit, it will refresh the page so you can fill the student form out again if you have another child!