EmailMe Form - St. James Generations Student Registration Form

Student Name *

First Last

Nickname

Birth Date *

MM / DD / YYYY

School *

Phone *

### - ### - ####

Preferably one that receives text

Email *

Emergency Contact *

First Last

Relationship *

Emergency Phone *

### - ### - ####

SOCIAL MEDIA CONTACT

Facebook

Twitter

Instagram

FAMILY INFORMATION

This section is only required for Students under the age of 18.

Parent / Guardian

First Last

Primary Email

Primary Phone

### - ### - ####

Text

Yes

No

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

AREAS OF INTEREST OF PARTICIPATION

Select all that apply *

CHURCH MEMBERSHIP / HISTORY

Member *

Yes

No

Saved *

Yes

No

Baptized *

Yes

No

Seeking Baptism

Yes

No

If seeking Baptism, has your child completed a Child Evangelism Class or Youth Evangelism Class?

Yes

No

STUDENT & FAMILY HISTORY

In caring for students, we believe it is our responsibility to seek an adult team that is able to provide healthy, safe, and nurturing relationships. Please answer the following questions accordingly.

Are there any special issues or concerns happening in your family right now that you would like for the Generations Department to be aware of or be sensitive to regarding your child? *

Does the Student have any food or drug allergies? *

Yes

No

If yes, please list:

Does the Student have any health conditions (asthma, etc….)? *

Yes

No

If yes, please list:

Is there any additional information that Generations should have pertaining to the Student? *

Yes

No

If yes, please explain:

SIGNATURES

Note: Parent/Guardian signatures are only required for Students under the age of 18.

I give the Generations Department consent to use my child/children pictures in any social media or in videos used for any ministry event

Yes

No

Student (Digital) Signature

Clear

The information contained in this Student Registration Form is correct to the best of my knowledge.

I, the undersigned, understand that the personal information in this application will be held confidential by the Generations Department.

Date Time

MM / DD / YYYY

Parent/Guardian (Digital) Signature

Clear

The information contained in this Student Registration Form is correct to the best of my knowledge.

I, the undersigned, understand that the personal information in this application will be held confidential by the Generations Department.

Date Time

MM / DD / YYYY

Parent/Guardian (Digital) Signature

Clear

The information contained in this Student Registration Form is correct to the best of my knowledge.

I, the undersigned, understand that the personal information in this application will be held confidential by the Generations Department.

Date Time

MM / DD / YYYY