MSM Registration Form 2020/21

Welcome to Middle School Ministries at Blackhawk Church! 

Please fill out this form if: 
You are new to Middle School Ministries
You are returning to your MSM Home Group
You are registering another student in your family
You would like to be on the email list for Middle School Ministries & you aren't currently receiving emails
If you have questions or need to update their information, please email MSM Admin, Heather Stahley (

*I am filling out this form to:
*Student First Name:
*Student Last Name:
Due to the uniqueness of the COVID season, we would like to encourage our small group leaders to reach out to students directly outside of regular programming a couple of times each semester.  If you are interested, please provide the best method for the leader to contact your student.
Student email:
Student Phone:
Student (other) contact method:
*What grade are you in 2020/21?:
*What school do you attend?:
*Parent/Guardian 1: First Name:
*Parent/Guardian 1: Last Name:
*Parent/Guardian 1: Cell phone number:
Home phone number:
*Parent/Guardian 1: Email:
Parent/Guardian 2: First Name:
Parent/Guardian 2: Last Name:
Parent/Guardian 2: Cell Phone number:
Parent/Guardian 2: Home phone number:
Parent/Guardian 2: Email:
*NEW* this year! At the request of parents in the ministry - who are looking to connect with others in the same phase of life, we would like to help facilitate contact sharing amongst parents in each Home Group. Would you like to opt in to sharing your information with other families?
Allergies or special dietary concerns:
Any other special considerations?:

2020/21 Home Group locations.  While during the current COVID season, we will be meeting mostly online, Home Groups are determined based on gender and geographic location (i.e. Waunakee Girls, West Madison Boys). Middleton area students will also be split further in order to keep those Home Groups to a manageable size (Middleton West/Glacier Creek and Middleton East/Kromrey). 

Based on your geographic location and gender, which Home Group would you attend? 
NOTE: While we strongly encourage students to attend the Home Group that fits this description, we realize there may be circumstances where a student wishes to attend elsewhere. If so, please choose the group your student wishes to attend.
*Home Group location:
Do you have friend(s) who are already in a Home Group?:
Appearance Release: As the legal parent/guardian for the minor child/student attending this programming, I understand that photographs and/or videos may be taken of my minor child/student during the course of this programming. I authorize and consent to the use of images or videos of my minor child/student by Blackhawk Church for purposes including, but limited to, promotional materials, internet posts including social media, and other media sources.
*Appearance Release Consent:

Thank you! We look forward to connecting with you and your students! 

If you have any questions regarding Home Groups, locations, serving, or general Middle School Ministry information,  please feel free to let us know and someone from our staff team will be in contact with you! (Optional)