Student Information

Please fill-in all information, and "submit." Info will be email to Scott Wedgeworth. - Thanks for your help!

(or return to Youth Ministry Page)

Name  Name you go by
Home Phone Cell Phone
Home Address Summer Address
City, State, Zip City, State, Zip
Email address
List any church related activities you will be involved in this summer
List non-church activities for the summer (sports, music, etc.)
Father's Name Mother's Name
Grade going into School going to
List any ideas of suggestions you have for the youth group. Please be as specific as possible

 

 

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