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.
*I am filling out this form to:
*Student First Name:
*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:
*Street Address:
*City:
*State:
*Zip Code:
*Gender (for assigning small groups):
*Birthdate:
*What grade are you in 2021/22?:
*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:
*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? 
*Community Group location:
*Which former Home Group area best describes you?Community Groups meeting in person at Blackhawk Brader Way site:
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.
*Appearance Release 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!