2021-2022 Discipleship Training Registration

DISCIPLESHIP TRAINING REGISTRATION FORM 2021-2022

  • STUDENT INFORMATION

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • CONTACT INFORMATION

  • Name of someone that can be contacted in an emergency, should one of the people listed above not be available.
  • EMERGENCY INFORMATION

  • Please list any allergies (food or other):
  • Please list any medical concerns that could affect the student while participating in events with the group:
  • Please list any conditions that could affect the student while participating in events with the group:
  • INSURANCE INFORMATION

    Please fill out this section if your student will be participating in any overnight activities.