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MSM Registration Form 2021/22
Welcome to Middle School Ministry at Blackhawk Church! To help us plan well for the ministry year, we are asking that you fill out this registration form even if you have been involved in MSM in the past. If you're unsure about Wednesday nights, filling out this form is the best way to stay connected & up to date on MSM. If you have questions, feel free to contact the MSM staff at hstahley@blackhawkchurch.org.
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I am filling out this form to:
Register for MSM Community Groups (new to the ministry).
Register for MSM Community Groups (was part of Home Group in previous years)
Get on the email list to update with MSM (not registering for Community Groups)
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Student First Name:
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Student Last Name:
We 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:
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Street Address:
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City:
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State:
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Zip Code:
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Gender (for assigning small groups):
-- Select --
Female small group
Male small group
Undecided
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Birthdate:
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What grade are you in 2021/22?:
-- Select --
Sixth
Seventh
Eighth
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What school do you attend?:
_________________________________________
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Parent/Guardian 1: First Name:
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Parent/Guardian 1: Last Name:
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Parent/Guardian 1: Cell phone number:
Home phone number:
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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:
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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 Community Group. Would you like to opt in to sharing your information with other families?
Yes
No
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Community Group location:
Blackhawk Brader Way (Middleton East / West groups)
Blackhawk Fitchburg (Fitchburg / Verona / West Madison / Oregon groups)
Waunakee
Mount Horeb
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Which former Home Group area best describes you?:
Middleton East
Middleton West
Fitchburg
Verona
West Madison
Waunakee
Mount Horeb
Oregon
I'm not sure / Other
Do you have friend(s) that you'd like to be in a Community Group with?:
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.
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Appearance Release Consent:
-- Select --
I authorize and consent.
I DO NOT authorize and consent.
Allergies or special dietary concerns:
Any other special considerations?:
If you have any questions regarding Community 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) Thank you! We look forward to connecting with you and your students!
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