Midweek Registration 2019

Please fill spaces below with attending student's information

*Address Line 1
Address Line 2
*Zip/Postal Code
*Grade Level
*School Name
*Parent Name
*Parent Email
*Emergency Contact Name & Number:
*Why would you like to be part of a midweek discipleship group?
*What does your daily walk with God look like? Be specific.
*Are you committed to joining a group for the school year?