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Senior High 10t25

Name: Senior High 10t25
Start: 2015-09-23T17:30:00-05:00
End: 2015-09-23T17:30:00-05:00

September 23, 2015 @ 5:30 pm

|Recurring Event (See all)

10t25 draws its purpose from the story of the Good Samaritan (Luke 10:25). We look to equip high school youth to be leaders and learn together what it means to walk with our peers.

Please register here:

10t25 Registration

Student Information
Student's Full Name*
Grade*
Date of Birth*
Student's Cell Phone
Student's Email
Address*
Street Address City State ZIP Code
Parent / Guardian 1
Name*
Email
Employer*
Phone 1*
Phone 1 Type*
Phone 2*
Phone 2 Type*
Address*
Same as student

Street Address City State ZIP Code
Parent / Guardian 2
Name
Email
Employer
Phone 1
Phone 1 Type
Phone 2
Phone 2 Type
Address
Same as student

Street Address City State ZIP Code
Emergency Contact
In case the parents / guardians cannot be reached.
Name*
Relationship to Student*
Phone 1*
Phone 1 Type*
Phone 2
Phone 2 Type
Student Medical Information
Medical information that the staff should be aware of.
Health Issues / Concerns
Medications
I give permission to:
- Use photographs of the student listed above on the Good Shepherd Lutheran Church social media / website.

Good Shepherd Lutheran Church

Calendar

Senior High 10t25

September 23, 2015 @ 5:30 pm

10t25 Registration

Student Information

Parent / Guardian 1

Parent / Guardian 2

Emergency Contact

Student Medical Information

Details

Organizer

Venue