EmailMe Form - Parent/Student Retreat Signup Form

Parent or Guardian's First and Last Name *

Will you attend? *

Yes - I will attend with them

No - I will not attend with them

Parents Phone Number *

Parent Email *

Does parent want a T-shirt? You will be responsible for purchasing your T-shirt. *

Yes

No

If you answered yes, please list Adult T-shirt sizes below.

List T-shirt sizes and number of T-shirts needed, separated by commas. See example below:
S - 2, M - 4, XL - 2, XXL - 2, etc.

First and Last Name of High School Senior *

Age of the High School Senior *

T-shirt Size Senior 1 *

2nd Additional Senior *

Yes

No

First and Last Name of High School Senior 2 *

Age of the High School Senior 2 *

T-shirt Size Senior 2 *

3rd Additional Senior *

Yes

No

First and Last Name of High School Senior 3 *

Age of the High School Senior 3 *

T-shirt Size Senior 3 *

4th Additional Senior *

Yes

No

First and Last Name of High School Senior 4 *

Age of the High School Senior 4 *

T-shirt Size Senior 4 *

5th Additional Senior *

Yes

No

First and Last Name of High School Senior 5 *

Age of the High School Senior 5 *

T-shirt Size Senior 5 *

Member of New Jerusalem - Greenville, MS *

Yes

No

Do you have a church home?

Yes

No

Your church home (if applicable)

If you don't have a church home, do you mind if we add you to our visitor text and invite you back to Worship with us on Sunday Morning? *

Yes - Invite Me

No - Don't Invite Me

If yes, please leave your mobile number below. Thank you!

Would you like to receive text messages in case any changes occur for this event? You will only receive texts about this event. *

Yes - Keep me informed

No - Don't keep me informed

If yes, please leave your mobile number below. Thank you!

Need to leave any additional information? Please do so below. Thanks!

We don't (New Jerusalem M. B. Church) disclose information (personal or general) collected by our site, via our online forms. Although, we won't ever ask for your personal information like Social Security Numbers, Account Numbers, etc.

We only use information collected from our online forms to tally a count of participants for events and to contact them in case of event updates and changes, to respond to members (if the online form is specifically for members of New Jerusalem), or to share any other pertinent communication that's needed, after online form information is submitted.