Student's name *
Male
Female
Grade (fall 2010) *
Parent's name *
Home address: *
Birth date *
MM/DD/YY
E-mail address *
Cell phone (if you have texting)
Our Student Ministry commmunicates via free text message updates.
Three students I'd like to be in the same group as
Anything else we need to know?
If there is any additional information we need to know before we place you in a group, let us know. If you know a certain small group leader you would like to have, put that here. If you know of a certain House Group you want to be a part of, put that here, too.
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Mt. Gilead Church | 6019 East State Road 144 | Mooresville, IN 46158 | 317.831.1900
